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Immunologic benefit of maternal donors in pediatric living donor liver transplantation
Author(s) -
Kim Michelle H.,
Akbari Omid,
Genyk Yuri,
Kohli Rohit,
Emamaullee Juliet
Publication year - 2019
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13560
Subject(s) - medicine , biliary atresia , immunosuppression , microchimerism , immune tolerance , liver transplantation , living donor liver transplantation , intensive care medicine , immune system , transplantation , pediatrics , immunology , fetus , pregnancy , surgery , genetics , biology
Purpose of review Long‐term follow‐up has suggested that pediatric LDLT may have superior outcomes compared to deceased donor recipients. In this review, we describe the subset of LDLT recipients with maternal donors that have lower reported rates of rejection and improved allograft survival. Recent findings Pediatric LDLT recipients, particularly those with a primary diagnosis of biliary atresia who receive grafts from their mothers, have been reported to have lower rates of acute cellular rejection post‐transplant and graft failure. Maternal‐fetal microchimerism and the persistence of regulatory T cells may be related to improved outcomes observed in recipients with maternal donors. Further, recent studies have shown that up to 60% of pediatric LDLT recipients can undergo intentional withdrawal of immunosuppression and achieve long‐term operational tolerance. The impact of graft type on operational tolerance has not been thoroughly investigated; however, investigation of tolerant pediatric LDLT patients with maternal donors may provide key insights into the mechanisms of immune tolerance. Summary While excellent outcomes can be achieved in pediatric LDLT, there is still a measurable decrease in graft and patient survival over time post‐transplant. Recipients of maternal donor liver transplants are a subset of patients who may be advantaged toward improved outcomes by means of immune tolerance.