Dynamics of Regulatory T cells in Liver Transplantation

Liver transplantation has become the only definitive therapy for end stage liver disease. In the early days of liver transplantation, short term patient and graft survival was strongly depending on the surgical technique and the immune system of the recipient. The first successful liver transplantation was performed by Dr. Thomas Starzl in 1967 (1). After the enhancement of the surgical technique with improvement of preservation solutions and operative strategy, adequate anti-rejection treatment was the key factor to further progress. A major step forward was set after the discovery of calcineurin inhibiting immunosuppressive agents: cyclosporine A and later tacrolimus. Cyclosporine was first introduced by Sir Roy Calne and colleagues in 1979 (2), causing a prominent improvement of patient and graft survival. Since then calcineurin inhibitors are universally applied in the immunosuppressive treatment following liver transplantation. Presently, the success of solid-organ transplantation depends on the continuous administration of immunosuppressive agents, which unfortunately are toxic and cause severe complications. These complications include increased risks for opportunistic infections, malignancy, cardiovascular and renal complications as well as a variety of agent-specific side effects. Immunosuppression-related complications are nowadays the most important determinants of long-term patient survival and quality of life (3, 4).

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