摘要
Shortage of appropriate donor grafts is the foremost current problem in organ transplantation. As a logical consequence, waiting times have extended and pretransplant mortality rates were significantly increasing. The implementation of a priority-based liver allocation system using the model of end-stage liverdisease(MELD) score helped to reduce waiting list mortality in liver transplantation(LT). However, due to an escalating organ scarcity, pre-LT MELD scores have significantly increased and liver recipients became more complex in recent years. This has finally led to posttransplant decreasing survival rates, attributed mainly to elevated rates of infectious and immunologic complications. To meet this challenging development, an increasing number of extended criteria donor grafts are currently accepted, which may, however, aggravate the patients' infectious and immunologic risk profiles. The administration of intravenous immunoglobulins(IVIg) is an established treatment in patients with immune deficiencies and other antibody-mediated diseases. In addition, IVIg was shown to be useful in treatment of several disorders caused by deterioration of the cellular immune system. It proved to be effective in preventing hyperacute rejection in highly sensitized kidney and heart transplants. In the liver transplant setting, the administration of specific Ig against hepatitis B virus is current standard in post-LT antiviral prophylaxis. The mechanisms of action of IVIg are complex and not fully understood. However, there is increasing experimental and clinical evidence that IVIg has an immuno-balancing impact by a combination of immuno-supporting and immuno-suppressive properties. It may be suggested that, especially in the context of a worsening organ shortage with all resulting clinical implications, liver transplant patients should benefit from immuno-regulatory capabilities of IVIg. In this review, perspectives of immune modulation by IVIg and impact on outcome in liver transplant patients are described.
Shortage of appropriate donor grafts is the foremostcurrent problem in organ transplantation. As a logicalconsequence, waiting times have extended andpretransplant mortality rates were significantly increasing.The implementation of a priority-based liverallocation system using the model of end-stage liverdisease （MELD） score helped to reduce waiting listmortality in liver transplantation （LT）. However, dueto an escalating organ scarcity, pre-LT MELD scoreshave significantly increased and liver recipients becamemore complex in recent years. This has finally led toposttransplant decreasing survival rates, attributedmainly to elevated rates of infectious and immunologiccomplications. To meet this challenging development,an increasing number of extended criteria donor graftsare currently accepted, which may, however, aggravatethe patients＇ infectious and immunologic risk profiles.The administration of intravenous immunoglobulins（IVIg） is an established treatment in patients withimmune deficiencies and other antibody-mediateddiseases. In addition, IVIg was shown to be useful intreatment of several disorders caused by deteriorationof the cellular immune system. It proved to be effectivein preventing hyperacute rejection in highly sensitizedkidney and heart transplants. In the liver transplantsetting, the administration of specific Ig againsthepatitis B virus is current standard in post-LT antiviralprophylaxis. The mechanisms of action of IVIg arecomplex and not fully understood. However, there isincreasing experimental and clinical evidence that IVIghas an immuno-balancing impact by a combinationof immuno-supporting and immuno-suppressiveproperties. It may be suggested that, especially in thecontext of a worsening organ shortage with all resultingclinical implications, liver transplant patients shouldbenefit from immuno-regulatory capabilities of IVIg.In this review, perspectives of immune modulation byIVIg and impact on outcome in liver transplant patientsare described.
