Immunology demystified: A guide for transplant hepatologists

Abstract

Liver transplantation has become standard practice for treating end-stage liver disease. The success of the procedure relies on effective immunosuppressive medications to control the host's immune response. Despite the liver's inherent capacity to foster tolerance, the early post-transplant period is marked by significant immune reactivity. To ensure favorable outcomes, it is imperative to identify and manage various rejection types, encompassing T-cell-mediated, antibody-mediated, and chronic rejection. However, the approach to prescribing immunosuppressants relies heavily on clinical judgment rather than evidence-based criteria. Given that the majority of patients will require lifelong immunosuppression as the mechanisms underlying operational tolerance are still being investigated, healthcare providers must possess an understanding of immune responses, rejection mechanisms, and the pathways targeted by immunosuppressive drugs. This knowledge enables customization of treatments and improved patient care, even though a consensus on an optimal immunosuppressive regimen remains elusive.

Keywords: Liver transplantation; Allograft rejection; Operational immune tolerance; Immune reaction; Immunosuppression

Core Tip: Liver transplantation is standard practice for treating end-stage liver disease, requiring effective immunosuppressive medications to regulate the recipient's immune response. In the post-transplant period, vigilance is necessary to recognize and manage various rejection types (T-cell-mediated, antibody-mediated, and chronic rejection). As the majority of patients require lifelong immunosuppression while the mechanisms of operational tolerance are still being explored, healthcare providers must possess a solid understanding of immune responses, rejection mechanisms, and the targets of immunosuppressive drugs. Despite the absence of consensus on an ideal immunosuppressive regimen, customization remain crucial.