Hepatic Infiltrates in Operational Tolerant Patients After Liver Transplantation Show Enrichment of Regulatory T Cells Before Proinflammatory Genes Are Downregulated
Author(s)
Type
Journal Article
Abstract
Immunosuppression can be discontinued from selected and stable patients after liver transplantation resulting in spontaneous operational tolerance (SOT), although the underlying mechanisms remain elusive. Thus, we analyzed serial liver biopsy specimens from adult liver recipients enrolled in a prospective multicenter immunosuppression withdrawal trial that used immunophenotyping and transcriptional profiling. Liver specimens were collected before the initiation of weaning, at the time of rejection, or at 1 and 3 years after complete drug discontinuation. Unexpectedly, the tolerated grafts developed portal tract expansion with increased T cell infiltration after immunosuppression withdrawal. This was associated with transient and preferential accumulation of CD4+FOXP3+ cells and a trend toward upregulation of immune activation and regulatory genes, without signs of rejection. At the same time, no markers of endothelial damage or activation were noted. Portal infiltrates persisted at 3 years but were characterized by decreased expression of genes associated with chronic immunological damage. Further, SOT was not associated with a progressive liver fibrosis up to 5 years. These data suggest that SOT involves several mechanisms: a long-lasting local immune cell persistence with a transient regulatory T cells accumulation followed by a downregulation of immune-activated genes over years. These results have important implications for designs and follow-up of weaning trials.
Date Issued
2016-02-18
Date Acceptance
2015-09-26
Citation
American Journal of Transplantation, 2016, 16 (4), pp.1285-1293
ISSN
1600-6135
Publisher
Wiley
Start Page
1285
End Page
1293
Journal / Book Title
American Journal of Transplantation
Volume
16
Issue
4
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
Transplantation
SOLID-ORGAN TRANSPLANTATION
IMMUNOSUPPRESSION WITHDRAWAL
RECIPIENTS
EXPRESSION
REJECTION
RATIO
Publication Status
Published