Tolerance in clinical transplantation: progress, challenge or just a dream?

Fändrich, F.

doi:10.1007/s00423-011-0757-z

Cited by 11 publications

(4 citation statements)

References 114 publications

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“…It must be admitted that the success of OLT is owed to the pioneers developing the surgical procedures and to the researchers discovering the available medications related to allograft rejection prevention [2]. Although liver allograft is generally considered immunologically privileged, and hyperacute rejection is rarely observed, the substantial short- and long-term morbidity associated with acute and chronic rejection have still set off a wave of investigators seeking a safe and effective immunosuppressive regimen for liver transplant recipients [3, 4]. …”

Section: Introductionmentioning

confidence: 99%

Role of steroid minimization in the tacrolimus-based immunosuppressive regimen for liver transplant recipients: a systematic review and meta-analysis of prospective randomized controlled trials

Lü

et al. 2014

Hepatol Int

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To evaluate the efficacy and safety of early steroid withdrawal or steroid avoidance in the tacrolimus (Tac)-based immunosuppressive regimen for liver transplant recipients. According to the requirements of the Cochrane systematic review, a thorough literature search was performed in the PubMed/MEDLINE and Cochrane electronic databases between 1995 and 2011 using the key words “liver transplantation,” “Tac,” and “steroid free” or “steroid withdrawal,” restricting articles to the English language. Data were processed for a meta-analysis by Stata 12 software. Altogether 17 prospective randomized controlled trials containing 1,980 transplanted patients were included in this study. The overall pooled RR estimates of 1-, 2-, 3-, and 5-year patient and graft survival rates were 0.985, 0.998, 0.995, and 1.100 (95 % CI 0.925–1.048, 0.934–1.067, 0.894–1.107, and 0.968–1.250, respectively), as well as 0.998, 0.993, 0.945, and 1.053, respectively (95 % CI 0.928–1.072, 0.902–1.092, 0.833–1.072, and 0.849–1.307, respectively). The other pooled RR estimates of acute rejection and chronic rejection rates for all enrolled studies were 1.077 and 0.311 (95 % CI 0.864–1.343 and 0.003–37.207). As for secondary predictors, the pooled RR estimates such as HCV recurrence, HCC recurrence, diabetes, hypertension, kidney dysfunction, bacterial infection, and CMV were 1.101, 1.403, 1.836, 1.607, 0.842, 1.096, and 2.280, respectively (95 % CI 0.964–1.257, 0.422–4.688, 1.294–2.606, 0.926–1.228, 0.693–1.022, 0.783–1.533, and 1.500–3.465, respectively). There were no differences between the steroid group and steroid-free group for all clinical observational indices except for the incidence of diabetes (p = 0.001) and CMV infection (p < 0.001). In summary, our study indicate that rapid discontinuation of steroid in the Tac-based immunosuppressive regimen may not lead to an increased risk of morbidity and rejection rate.Electronic supplementary materialThe online version of this article (doi:10.1007/s12072-014-9523-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Role of steroid minimization in the tacrolimus-based immunosuppressive regimen for liver transplant recipients: a systematic review and meta-analysis of prospective randomized controlled trials

Lü

et al. 2014

Hepatol Int

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“…Mesenchymal stem cells (MSCs) were shown to fulfill this premise and have recently gained great attention for their use in solid organ transplantation [46,47]. In addition, MSCs are currently applied to prevent and treat GvHD after BM transplantation and to prevent acute rejection episodes after solid organ transplantation [48]. Kuo ?…”

Section: Discussionmentioning

confidence: 99%

Minimization of Immunosuppression and Tolerance Induction in Reconstructive Transplantation

et al. 2012

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Vascularized composite allotransplantation (VCA) is an innovative reconstructive modality for patients sustaining complex injuries not amenable to conventional treatment. Advances in immunosuppression have made VCA a clinical reality and a valid reconstructive option for such patients. The requirement, however, for multi-drug high-dose immunosuppressive regimens with their numerous side effects has hindered widespread clinical application of VCA. There is thus a need for novel immunologic modalities to minimize or even obviate the need for immunosuppression (tolerance induction) while still preserving the allograft and preventing rejection. Recent advances in targeted immunotherapy and cell-based protocols were able to achieve tolerance in selected cases of solid organ transplantation. This paved the way for innovative immunomodulatory protocols now also applied to VCA that aim for minimal immunosuppression or for induction of donor-specific tolerance. These concepts and novel protocols will be discussed in this review.

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“…As one of their immunomodulatory mechanisms, MSCs are thought to downregulate overshooting immune responses in various different clinical conditions. In addition, MSCs are currently applied to prevent and treat GvHD after BM transplantation and to prevent acute rejection episodes after both cell and solid organ transplantation [88,89]. Most recently, Kuo et al have shown prolonged allograft survival of vascularized composite tissue grafts by treatment with BM-derived MSCs that were correlated with a significant increase in the percentage of CD4 + /CD25 + and CD4 + /FoxP3 + T cells in both peripheral blood and intragraft tissues in a swine hindlimb model [90].…”

Section: Future Researchmentioning

confidence: 99%