Japanese Journal of Clinical Immunology

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In our experience of living donor liver transplantation (LDLT), some recipients could be successfully weaned from any immunosuppressant in case of various situations like severe infectious complications, posttransplant lymphoproliferative disorder, and noncompliance. Based on such unexpected experiences, we started the intentional weaning of immunosuppressants after LDLT. The patients were selected among the recipients who had been followed up longer than two years with stable normal graft function, and without any rejection episodes in the latest one year. So far, 26 cases were enrolled into this program, and 6 cases could be intentionally weaned from any immunosuppressants. Four recipients unfortunately had a rejection episode during the weaning. Immunosuppressants were again returned to the pre-weaning level in these recipients, and the rejection could be treated without any persistent dysfunction of the graft. Clear discrimination of the recipients who will be or will not be able to be weaned from immunosuppresion is still impossible. Mixed lymphocyte reaction showed tendency of low response to the donor, but the result is not stationary in all recipients. Identification of suitable parameters to promise the possibility of weaning is a big problem to be solved in the future.

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To solve adverse effects of high dose steroid administration for patients with moderately severe and severe ulcerative colitis (UC), additional use of leukocytapheresis (LCAP) was tried to settle colonic inflammation. We evaluated immunological changes in the treatment of LCAP using leukocyte removal filter for UC patients. We then assessed the clinical effectiveness of LCAP compared with that of high dose of steroid therapy. LCAP removed monocytes, granulocytes, and lymphocytes presenting CD 11 b⁺, CD 11 c⁺, and HLADR⁺, selectively from the patients. Proinflammatory cytokine priductions measured such as TNFα, IL-1β, and IL 8 reduced and IL 10 increased immediately after LCAP compared with before perfusion. Improved rate was about 70% for LCAP group and about 40% for high dose steroid group (Refer J Gastroenterol). Selective removal of granulocyte, monocytes, and activated lymphocytes inhibits proinflammatory cytokine production and inceases immune modulating cytokine productions (Refer Therapeutic Apheresis). Then quick inhibition of several inflammatory deteriorated factors simultaneously controls the activity and clinical symptoms of UC with less severe adverse effects. It can be considered one option for treatment of UC.

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