Clinical operational tolerance in liver transplantation:state-of-the-art perspective and future prospects

BACKGROUND:Liver transplantation is the definite treatment for end-stage liver diseases with satisfactory results.However,untoward effects of life-long immunosuppression prevent the development of alternative strategies to achieve better longterm outcome.Achieving clinical operational tolerance is the ultimate goal.DATA SOURCES:A PubMed and Google Scholar search using terms:"immune tolerance","liver transplantation","clinical trial","operational tolerance" and "immunosuppression withdrawal" was performed,and relevant articles published in English in the past decade were reviewed.Full-text publications relevant to the field were selected and relevant articles from reference lists were also included.Priority was given to those articles which are relevant to the review.RESULTS:Because of the inherent tolerogenic property,around 20%-30% of liver transplantation recipients develop spontaneous operational tolerance after immunosuppression withdrawal,and the percentage may be even higher in pediatric living donor liver transplantation recipients.Several natural killer and γδT cell related markers have been identified to be associated with the tolerant state in liver transplantation patients.Despite the progress,clinical operational tolerance is still rare in liver transplantation.Reprogramming the recipient immune system by creating chimerism and regulatory cell therapies is among newer promising means to achieve clinical liver transplantation tolerance in the future.CONCLUSION:Although clinical operational tolerance is still rare in liver transplantation recipients,ongoing basic research and collaborative clinical trials may help to decipher the mystery of transplantation tolerance and extend the potential benefits of drug withdrawal to an increasing number of patients in a more predictable fashion.

Self-management and self-efficacy status in liver recipients

BACKGROUND： Liver transplantation （LT） is a viable treatment for patients with end-stage chronic liver diseases. The main aim of LT is to prolong life and improve life quality. However, although survival after LT continues to improve, some aspects of recipient＇s health-related quality of life such as self-man- agement and self-efficacy have been largely ignored.

MicroRNAs and long non-coding RNAs in liver surgery:Diagnostic and therapeutic merits

Background:Hepatectomy and liver transplantation(LT)are the two most commonly performed surgical procedures for various hepatic lesions.micro RNA(mi RNA)and long non-coding RNA(lnc RNA)have been gradually unveiled their roles as either biomarkers for early diagnosis or potentially therapeutic tools to manipulate gene expression in many disease entities.This review aimed to discuss the effects of mi RNA or lnc RNA in the hepatectomy and LT fields.Data sources:We did a literature search from 1990 through January 2018 to summarize the currently available evidence with respect to the effects of mi RNA and lnc RNA in liver regeneration after partial hepatectomy,as well as their involvement in several key issues related to LT,including ischemia-reperfusion injury,allograft rejection,tolerance,recurrence of original hepatic malignancies,etc.Results:Certain mi RNAs and lnc RNAs are actively involved in the regulation of various aspects of liver resection and transplantation.During the process of liver regeneration after hepatectomy,the expression of mi RNAs and lnc RNAs shows dynamic changes.Conclusions:It is now clear that mi RNAs and lnc RNAs orchestrate in various aspects of the pathophysiological process of LT and hepatectomy.Better understanding of the underlying mechanism and future clinical trials may strengthen their positions as either biomarkers or potential therapeutic targets in the management of complications after liver surgery.