TY - JOUR
T1 - New Approaches to the Diagnosis of Rejection and Prediction of Tolerance in Liver Transplantation
AU - Taner, Timucin
AU - Bruner, Julia
AU - Emamaullee, Juliet
AU - Bonaccorsi-Riani, Eliano
AU - Zarrinpar, Ali
N1 - Funding Information:
Following were the funding received for this study: National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases K08DK113244 (A.Z.); Fund for Scientific Research Fonds National de la Recherche Scientifique Specialist Post-Doctorate Grant, Belgium (E.B.-R.); National Institutes of Health National Cancer Institute K08CA245220 (J.E.); American Society of Transplant Surgeons Faculty Development Grant (J.E.); American Association for the Study of Liver Diseases Clinical, Translational, and Outcomes Research Award (J.E.); and Gilead Research Foundation Liver Scholar Award (J.E.).
Publisher Copyright:
© 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Immunosuppression after liver transplantation is essential for preventing allograft rejection. However, long-term drug toxicity and associated complications necessitate investigation of immunosuppression minimization and withdrawal protocols. Development of such protocols is hindered by reliance on current paradigms for monitoring allograft function and rejection status. The current standard of care for diagnosis of rejection is histopathologic assessment and grading of liver biopsies in accordance with the Banff Rejection Activity Index. However, this method is limited by cost, sampling variability, and interobserver variation. Moreover, the invasive nature of biopsy increases the risk of patient complications. Incorporating noninvasive techniques may supplement existing methods through improved understanding of rejection causes, hepatic spatial architecture, and the role of idiopathic fibroinflammatory regions. These techniques may also aid in quantification and help integrate emerging -omics analyses with current assessments. Alternatively, emerging noninvasive methods show potential to detect and distinguish between different types of rejection while minimizing risk of adverse advents. Although biomarkers have yet to replace biopsy, preliminary studies suggest that several classes of analytes may be used to detect rejection with greater sensitivity and in earlier stages than traditional methods, possibly when coupled with artificial intelligence. Here, we provide an overview of the latest efforts in optimizing the diagnosis of rejection in liver transplantation.
AB - Immunosuppression after liver transplantation is essential for preventing allograft rejection. However, long-term drug toxicity and associated complications necessitate investigation of immunosuppression minimization and withdrawal protocols. Development of such protocols is hindered by reliance on current paradigms for monitoring allograft function and rejection status. The current standard of care for diagnosis of rejection is histopathologic assessment and grading of liver biopsies in accordance with the Banff Rejection Activity Index. However, this method is limited by cost, sampling variability, and interobserver variation. Moreover, the invasive nature of biopsy increases the risk of patient complications. Incorporating noninvasive techniques may supplement existing methods through improved understanding of rejection causes, hepatic spatial architecture, and the role of idiopathic fibroinflammatory regions. These techniques may also aid in quantification and help integrate emerging -omics analyses with current assessments. Alternatively, emerging noninvasive methods show potential to detect and distinguish between different types of rejection while minimizing risk of adverse advents. Although biomarkers have yet to replace biopsy, preliminary studies suggest that several classes of analytes may be used to detect rejection with greater sensitivity and in earlier stages than traditional methods, possibly when coupled with artificial intelligence. Here, we provide an overview of the latest efforts in optimizing the diagnosis of rejection in liver transplantation.
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U2 - 10.1097/TP.0000000000004160
DO - 10.1097/TP.0000000000004160
M3 - Review article
C2 - 35594482
AN - SCOPUS:85138926418
SN - 0041-1337
VL - 106
SP - 1952
EP - 1962
JO - Transplantation
JF - Transplantation
IS - 10
ER -