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Die allogene Lebertransplantation

II. Immunologische Untersuchungen am Schwein

The allogeneic liver transplantation

II. Immunological Examinations in Pigs

  • Review Article
  • Published:
Research in Experimental Medicine

Summary

Although pig liver allograft induces a regular cellular immune response the transplantated liver shows only mild rejection or can be accepted. Long term survivors show a reduced cellular immunity in vitro involving the lack of donor-specific memory cells and the development of blocking antibodies. These immunoglobulins are mainly considered to mediate the increased survival time of the grafted liver. They show anti-Ia-like specifities and their induction is favoured by the particular Ia- and SD-antigen pattern of the liver tissue. The immunological status observed in liver-allografted pigs is comparable to the active enhancement.

In terms of morphological, functional and immunological changes the clinical liver transplantation shows striking similarities to the experimental animal model with pigs. The predominant, non-immunological complications could be overcome in the past few years so that the one-year survival rate was increased to 50%. The good survival rate and the low rejection risk due to the immunological peculiarity of the liver seem to justify the clinical application of the liver transplantation in cases of severe liver disorders which cannot be treated by conventional clinical methods.

Zusammenfassung

Ein allogenes Lebertransplantat induziert beim Schwein eine regelrechte zelluläre Immunantwort; dennoch wird dieses Lebertransplantat vermindert oder nicht abgestoßen. Bei Langzeitüberlebern ist in vitro die Koexistenz von reduzierter zellulärer Immunreaktion mit Verlust des „memory-cell-Effektes“ und blockierenden Antikörpern zu messen. Diesen blockierenden Antikörpern wird der eigentliche transplantatverlängernde Effekt zugeschrieben; er wird als Anti-Ia-ähnlicher Antikörper bezeichnet, dessen Entstehung durch das unterschiedliche Verteilungsmuster der SD- und Ia-Antigene in der Leber begünstigt wird. Der bei lebertransplantierten Schweinen induzierte Immunvorgang ist dem des aktiven Enhancement zu vergleichen.

In der klinischen Lebertransplantation werden sowohl bei den morphologisch-funktionellen als auch bei den immunologischen Veränderungen auffallende Parallelen zum Tiermodell des Schweines gefunden. Die bei der klinischen Lebertransplantation vorherrschenden, nicht immunologischen Komplikationen konnten in den letzten Jahren reduziert und die Einjahrüberlebensrate auf 50% erhöht werden. Dieser Erfahrungswert sowie die „immunologische Besonderheit“ der Leber lassen es gerechtfertigt erscheinen, die allogene Lebertransplantation als klinische Behandlungsmethode bei schweren und konservativ nicht mehr behandelbaren Lebererkrankungen einzusetzen.

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  1. Chirurgische Klinik und Poliklinik, Universität Tübingen, D-7400, Tübingen, Bundesrepublik Deutschland

    H. Bockhorn

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Diese Arbeit wurde zum Teil von der Deutschen Forschungsgemeinschaft gefördert (DFG-Bo 543/2)

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Bockhorn, H. Die allogene Lebertransplantation. Res. Exp. Med. 178, 177–199 (1981). https://doi.org/10.1007/BF01851007

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  • DOI: https://doi.org/10.1007/BF01851007

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