Immunological assessment of peripheral lymphocytes of patientsafter living related liver transplantation

我们减少了活体肝移植（LRLT）后肝功能稳定和正常的患者的免疫抑制。对于LRLT后患者的免疫学分析，我们测量了Th 1细胞因子，结果：①供者或第三方淋巴细胞混合淋巴细胞反应（MLR）流出液中IL-2、IFN的平均值：①供者MLR流出液中IL-2、IFN的平均值：②供者MLR流出液中IL-2、IFN的平均值：③供者MLR流出液中IL-2、IFN的平均值抗第三方抗体（分别为27.5pg/ml和88.2pg/ml）明显低于抗第三方抗体（分别为3.8pg/ml和24.1pg/ml）。与尸体移植相比，LRLT的优势可能在于移植前对相关供者的低反应性，这可能是由于HLA半相合组合所致。2）移植后免疫抑制时间超过2年的肝功能稳定和正常患者的MLR，小剂量免疫抑制患者的流出液IL-2和IFN水平高于大剂量免疫抑制患者。此外，与第三方相比，这些患者对供体的低反应性仍然存在。这表明，免疫抑制可以减少，只要肝功能是稳定的，在MLR流出物中的细胞因子水平高。3）对7例肝功能稳定正常、无免疫抑制的患者进行了MLR，MLR流出液中细胞因子水平与供者相似。提示临床耐受患者的外周血淋巴细胞对供者未获得耐受。进一步的研究重点是免疫反应，包括HLA抗原的表达，以阐明耐受的机制。

We have reduced immunosuppression of patients with stable and normal liver function after living related liver transplantation (LRLT). For immunological analysis in patients after LRLT, we measured Th1 cytokines (IL-2, IFN) in the effluent of mixed lymphocyte reaction (MLR) against lymphocytes of donors or third party persons.1)MLR patients before transplantation.The mean values of IL-2 and IFN in the effluent in MLR against donors ( 3.8 pg/ml and 24.1 pg/ml, respectively) were significantly lower than those against third party (27.5 pg/ml, 88.2 pg/ml, respectively). This hyporesponsiveness against related donors prior to transplantation presumably due to HLA haploidentical combination could be an advantage of LRLT compared to cadaveric transplantation.2)MLR in patients with stable and normal liver functions under immunosuppression longer than 2 years after transplantation.The effluent levels of IL-2 and IFN in patients with smaller doses of immunosuppression were greater than those in patients with larger doses. Further, the hyporesponsiveness against donors compared to the third party were remained in these patients. It is suggested that immunosuppression can be reduced as far as the liver functions are stable and the cytokine levels in the MLR effluent are high. Currently, a protocol of prospective reduction of immunosuppression is successfully carried out based on this findings.3)MLR in 7 patients with stable and normal liver functions with no immunosuppression.The cytokine levels in the effluent of MLR against donors are similar to those against third party. It is suggested that the peripheral lymphocytes of the patients in clinical tolerance do not acquired tolerance to donor. Further study focusing on the immunoreaction in the accepted organs including expression of HLA antigens is required to clarify the mechanism of the tolerance.