Liver transplantation immunology: immunosuppression, rejection, and immunomodulation
Open accessAbstract
Outcomes after liver transplantation have continuously improved over the past decades, but long-term survival rates are still lower than in the general population. The liver has distinct immunological functions linked to its unique anatomical configuration and to its harbouring of a large number of cells with fundamental immunological roles. The transplanted liver can modulate the immunological system of the recipient to promote tolerance, thus offering the potential for less aggressive immunosuppression. The selection and adjustment of immunosuppressive drugs should be individualised to optimally control alloreactivity while mitigating toxicities. Routine laboratory tests are not accurate enough to make a confident diagnosis of allograft rejection. Although several promising biomarkers are being investigated, none of them is sufficiently validated for routine use; hence, liver biopsy remains necessary to guide clinical decisions. Recently, there has been an exponential increase in the use of immune checkpoint inhibitors due to the unquestionable oncological benefits they provide for many patients with advanced-stage tumours. It is expected that their use will also increase in liver transplant recipients and that this might affect the incidence of allograft rejection. Currently, the evidence regarding the efficacy and safety of immune checkpoint inhibitors in liver transplant recipients is limited and cases of severe allograft rejection have been reported. In this review, we discuss the clinical relevance of alloimmune disease, the role of minimisation/withdrawal of immunosuppression, and provide practical guidance for using checkpoint inhibitors in liver transplant recipients.
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Immunosuppressive medications may have a deleterious impact on metabolic function.
“In addition, immunosuppressive medications may have a deleterious impact on metabolic function. 510”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [510]
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Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210 · see citing works
Merkel cell carcinoma: an updated review focused on bone and bone marrow metastases
Scotti, B., Broseghini, E., Ricci, C., Corti, B., Viola, C., Misciali, C., Baraldi, C., Vaccari, S., Lambertini, M., Venturi, F., et al. (2025) · Cancers · doi:10.3390/cancers17132253 · Cited by 9 · see citing works
- Authors
- Montano-Loza, A. J., Rodríguez-Perálvarez, M. L., Pageaux, G.-P., Sanchez-Fueyo, A., & Feng, S.
- Affiliations
- Université de Montpellier (FR)
- University of California, San Francisco (US)
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2023-06
- Volume
- 78
- Issue
- 6
- Pages
- 1199-1215
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W4376866235
- Cited by
- 208
- References
- 165
- Citations by year
- 2026: 76 · 2025: 74 · 2024: 51 · 2023: 7
- FWCI
- 13.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council (MR/P007694/1)
- Topics
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Keywords
- liver transplantation, immunosuppression, allograft rejection, immunomodulation, immunosuppression withdrawal, immune checkpoint inhibitors, liver biopsy, rejection biomarkers, alloreactivity, transplant recipient survival
- MeSH terms
- Immune Checkpoint Inhibitors, Graft Rejection, Humans, Immunosuppression Therapy, Immunosuppressive Agents, Liver, Transplantation Immunology, Liver Transplantation, Immunomodulation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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