Characteristics of recipients who achieved spontaneous operational tolerance in adult liver transplantation

Abstract

Background: Chronic immunosuppression is associated with unwanted adverse effects and increased morbidities. Long-term acceptance of transplanted organs without the requirement for immunosuppression, or operational tolerance, remains an important goal in clinical transplantation.

Methods: We reviewed the characteristics of recipients who achieved spontaneous operational tolerance after liver transplantation (OLT) among a consecutive series of 1014 adult recipients in a single center.

Results: We observed 5 cases (0.5%) of operational tolerance. All cases were men who underwent transplantations for hepatitis B virus-related liver cirrhosis. The mean time from OLT to achievement of spontaneous operational tolerance was 83.1 ± 62.9 months (range, 21.3-156.2). Characteristics common to all tolerant recipients were superior graft quality and good pretransplant recipient condition: specifically, high graft-recipient weight ratio (median, 1.18; range, 1.15-2.69), low hepatic macrosteatosis (median, 3; range, 0-15), low score of model for end-stage liver disease (median, 13; range, 7-21), and no history of preoperative intensive care.