Abstract
Rejection after organ transplantation is a cause of graft failure. Effectively reducing rejection and inducing tolerance is a challenge in the field of transplantation immunology. The liver, as an immunologically privileged organ, has high rates of spontaneous and operational tolerance after transplantation, allowing it to maintain its normal function for long periods. Although modern immunosuppression regimens have serious toxicity and side effects, it is very risky to discontinue immunosuppression regimens blindly. A more effective treatment to induce immune tolerance is the most sought-after goal in transplant medicine. Tregs have been shown to play a pivotal role in the regulation of immune balance, and infusion of Tregs can also effectively prevent rejection and cure autoimmune diseases without significant side effects. Given the immune characteristics of the liver, the correct use of Tregs can more effectively induce the occurrence of operational tolerance for liver transplants than for other organ transplants. This review mainly summarizes the latest research advances regarding the characteristics of the hepatic immune microenvironment, operational tolerance, Treg generation in vitro, and the application of Tregs in liver transplantation. It is hoped that this review will provide a deeper understanding of Tregs as the most effective treatment to induce and maintain operational tolerance after liver transplantation.
Highlights
Liver transplantation is effective for end-stage liver disease and acute liver failure, even when used as the sole treatment [1]
Treg in Liver Transplantation insufficiency and renal failure, cholangitis and bile duct stones caused by biliary tract injury, and tumours caused by immunodeficiency [2]
A small number of transplant recipients have shown no signs of rejection and good graft function with long-term discontinuation of immunosuppressants, a phenomenon known as spontaneous operational tolerance [4]
Summary
Liver transplantation is effective for end-stage liver disease and acute liver failure, even when used as the sole treatment [1]. Modern immunosuppression regimens have greatly reduced the early mortality of transplant patients. The study of immune tolerance induction has achieved promising results in animal experiments; for example, allografts could maintain good graft function without the use of immunosuppression regimens. A small number of transplant recipients have shown no signs of rejection and good graft function with long-term discontinuation of immunosuppressants, a phenomenon known as spontaneous operational tolerance [4]. Tregs are a subgroup of immune cells with strong regulatory functions that play an important role in maintaining immune homeostasis and inducing immune tolerance [6]. Multiple centres have applied in vitro-induced Tregs to the induction of early or late tolerance in patients with liver transplantation, and some progress has been achieved [11]. This review will systematically summarize the latest research progress and look forward to future research directions
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