Page 21 - CIBEREHD-2015-eng

Immunology, Cell Therapy and Liver Transplantation
COORDINADOR: DR. MIQUEL NAVASA
Liver transplantation is the treatment for chronic liver diseases in the terminal stage and for acute liv- er diseases which go along with severe acute liver failure. It is also the final treatment for liver tumours such as hepatocellular carcinoma. This treatment has several traits: the first is that it is associated with an allogenic immune response which attempts to reject the implant so that the treatment becomes an immunological disease requiring the use of immu- nosuppressors to control this. The use of immuno- suppressors in turn causes different diseases such as diabetes, high blood pressure, kidney failure, en- dothelial disorders, which very significantly increase these patients’ cardiovascular risk. Similarly, the re- duction of immune vigilance causes the appearance of neoplasias which are the main cause of death of these patients in the long term. Lastly, another of the problems involved in transplants is ischaemia rep- erfusion injury, both static (liver in the freezer with different conservation liquids), and dynamic (ex vivo perfusion of the implant). It is thus difficult to define the transplant as simply a treatment and it would seem more proper to define this as the only treat- ment which prolongs the survival of the patients with terminal chronic hepatopathy or acute hepato- pathy with severe liver failure but which generates new diseases whose study and control is highly im- portant to increase patients’ survival.
Most important achievements:
Prior studies of our group showed that before with- drawing the immunosuppressor medication, patients with operational tolerance and non-tolerant patients were differentiated in the expression of genes related with the homeostasis of Fe. The group has recent- ly shown that small changes in the homeostasis of iron can have a significant effect on the regulation of the intrahepatocytary lymphocytic response, mean- ing that iron deprivation deteriorates the activation and proliferation of intrahepatic lymphocytes, which is associated with a beneficial effect in autoimmune hepatitis.
New targets for therapeutic action have been estab- lished, based on modulating adipocytokines in liver transplant in marginal organs. The results obtained have also enabled taking part in competitive pro- grammes intended for translation of experimental results to clinical practice, so that the use of steatot- ic livers can be increased. The role of polyethylene glycol in preservation solutions for grafts has been established, indicating that better and longer conser- vation of organs can be guaranteed.
From the clinical standpoint we should stress a study which evaluates the hepatorenal syndrome in patients in the waiting list for a transplant and a study which shows the relevance of tuberculosis in transplanted patients. Two studies have evaluated alterations of the metabolism of carbohydrates and the impact of cardiovascular risk in patients with a liver transplant. The use of everolimus de novo and the effect on the renal function has also been evalu- ated. Researchers from the Programme have taken part in the preparation of the consensus document: V Consensus Meeting of the Spanish Society for Liver Transplant on high-risk recipients, immunosup- pression scenarios and management of hepatocar- cinoma on the transplant waiting list of the Sociedad Española de Trasplante Hepático. Gastroenterol Hepatol. 2015 Dec;38(10):600-18.
Scientific Programmes
CIBEREHD I Annual report 2015 I 21