Complete Withdraw from Immunosuppressants by Intraportal Administration of Donor Blood in Living-Related Liver Transplantation

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Background Oral or portal administration of allogeneic antigens downregulates the alloimmune response and prolongs graft survival following organ transplantation. However, the effect of donor specific transfusion (DST) via portal vein has been reported in rodent models, there has not been reported in human cases. We investigated whether DST via portal vein would bring up the clinical and immunological benefits in living related donor liver transplantation (LRDLT).Methods The eighteen patients who underwent LRDLT from March 1999 to December 2001, were investigated. Seven patients were given the Tac + steroid regimen (I.P.(-) group : n=7, mean age 54±9y.o. ). Eleven patients were performed postoperative repeated DST via portal venous catheter inserted from vena colica media besides from the Tac + steroid (I.P.(+) group : n=11, mean age 45±15y.o.). The clinical effects about the reduction of immunosuppresions and the rejection, and the immunological analysis were studied in the two groups … More .Results Total amount of methylprednisolone and prednisolone within one month in IP(+) group was smaller than that in IP(-) group with statistical significance. Amount of Tac within one month and Trough level of Tac was statistically smaller in IP(+) group than that in IP(-) group. Minimum dose of Tac in IP(+) group was clearly smaller than that in IP(-) group with statistical significance. The frequency of acute cellular rejection (ACR) within one month and after one month or total frequency of ACR in IP(+) group tended to be less than those in IP(-) group. Macrochimerism of donor type CD56+ T cells in a graft were confirmed in patients with DST via the portal vein. Conversely recipient type CD56+T cells increased in the graft liver in patients without DST. IL-10 production of DST(+) group were higher than that of DST (-) group on day 1 after LRDLT.Conclusions The repeated DST via portal vein has brought the rapid reduction of immunosuppressants. Donor type NKT cells especially CD56+ T cells, may induce tolerance by veto mechanism and anti-idiotype network mechanism. These benefits might introduce more advantages in frequencies of complications and cost of transplantation. Less