vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2021-3-162-170vtio-1332Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSТолерантность и минимизация иммуносупрессивной терапии после трансплантации печениTolerance and minimization of immunosuppressive therapy after liver transplantationГерасимоваО. А.GerasimovaO. A.

Герасимова Ольга Анатольевна, доктор медицинских наук, ведущий научный сотрудник отдела интервенционной радиологии и оперативной хирургии, руководитель амбулаторного центра трансплантологии, гепатологии и нефрологии ФГБУ РНЦРХТ им. ак. А.М. Гранова; профессор научно-клинического и образовательного центра гасроэнтерологии и гепатологии Санкт-Петербургского университета

197758, Санкт-Петербург, п. Песочный, ул. Ленинградская, 70

Olga A. Gerasimova

70, Leningradskaya str., Pesochny settlement, St. Petersburg, 197758

ren321@mail.ruБоровикВ. В.BorovikV. V.

Боровик Владимир Владимирович, главный врач клиники РНЦРХТ, кандидат медицинских наук

Санкт-Петербург

 

St. Petersburg

vv_borovik@rrcrst.ruМарченкоН. В.MarchenkoN. V.

Марченко Наталья Валерьевна, кандидат медицинских наук, врач-гастроэнтеролог амбулаторного центра трансплантологии, гепатологии и нефрологии

Санкт-Петербург

St. Petersburg

dr.marchenko@gmail.comТилеубергеновИ. И.TileubergenovI. I.

Тилеубергенов Инхат Ибрагимович, кандидат медицинских наук, руководитель группы трансплантационной хирургии

Санкт-Петербург

St. Petersburg

inkhat@mail.ruФГБУ «Российский научный центр радиологии и хирургических технологий имени академика А.М. Гранова» Минздрава РФ; ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург, Российская ФедерацияРоссияGranov Russian Scientific Center of Radiology and Surgical Technology; Saint-Petersburg State UniversityRussian FederationФГБУ «Российский научный центр радиологии и хирургических технологий имени академика А.М. Гранова» Минздрава РФРоссияGranov Russian Scientific Center of Radiology and Surgical TechnologyRussian Federation202117092021233162170Copyright © Герасимова О.А., Боровик В.В., Марченко Н.В., Тилеубергенов И.И., 20212021Герасимова О.А., Боровик В.В., Марченко Н.В., Тилеубергенов И.И.Gerasimova O.A., Borovik V.V., Marchenko N.V., Tileubergenov I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1332

В обзоре современных публикаций рассматриваются молекулярные механизмы толерантности печени и ее аллотрансплантатов в аспекте минимизации и возможностей отмены иммуносупрессивной терапии, главным образом, в отдаленном периоде после трансплантации печени. Представлены сведения о клинических испытаниях Treg с целью индукции толерантности. Продемонстрированы данные нового консенсусного исследования об индивидуализации режимов иммуносупрессивной терапии. Рассматриваются варианты возможной отмены иммуносупрессии как в ранние, так и в отдаленные сроки после ТП. Предлагается к исследованию путь изучения лимфопролиферативного потенциала реципиента трансплантата печени, поскольку не только отторжением определяется продолжительность жизни, но и степенью влияния иммуносупрессии на костный мозг в зависимости от возраста пациента.

In this review of current publications, we look at the molecular mechanisms of tolerance of the liver and its allografts in terms of minimization and possibilities of withdrawing immunosuppressive therapy, mainly in the long-term period after liver transplantation. Information about clinical trials with regulatory T cells (Tregs) for the purpose of tolerance induction is presented. Data from a new consensus study on individualization of immunosuppressive therapy regimens are presented. Options for possible withdrawal of immunosuppression both in the early and in the long term after liver transplantation (LT) are considered. We suggest a way to study the lymphoproliferative potential of a liver transplant recipient to be investigated, since not only rejection determines life expectancy, but also the degree of immunosuppression effect on bone marrow depending on patient age.

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The authors declare that there are no conflicts of interest present.