Author details

The other alternative to blood group incompatible liver transplant is liver paired exchange. This requires a very high level of coordination between multiple transplant teams as it can be a logistical puzzle. A paired exchange liver transplant in essence, offers superior survival advantage over an ABO-i liver transplant, but the level of communication can strain the system to fail. There are also socio-cultural issues amongst patients in accepting someone else's organ, therefore the success rate of liver exchange matching can be as low as <10% [47]. But its

ABO-i liver transplants have a valuable role in patients where socio-cultural barriers deter them from participating in the exchange program. At the same time, certain patients cannot tolerate higher level of immunosuppression and therefore will not be suitable for an ABO-i liver transplant, requiring higher levels of immunosuppression and immune-modulation. But, the availability of multiple options offer valuable and real choices for patients, that meet their

The liver has been considered very tolerant in solid organ transplantation, but its mechanism is still unclear. Application of regulatory T (T-reg) cells are in experimental stages, but have offered promising early results in solid organ transplantation including LDLT. However, most studies have focused on the applicability and short-term success as of now, but there is a real concern of

After the first decade following the inception of LDLT, there were refinements to the surgical technique and in the process of evaluation to select a suitable donor. There were also lessons learnt on how best to select a suitable recipient for LDLT. After being surgically refined, the second decade offered advancements to the learnt lessons on how to extend the donor acceptance boundaries, and at the same time, how best to match the extended spectrum donor to the

conceptual possibility has been well established with excellent outcomes.

Figure 7. Adult to adult living donor liver transplant, using dual grafts [44].

individual needs and agrees with their beliefs.

chronic rejection with auto-antigens in T-reg therapies.

7.3. Tolerance in liver transplant

176 Liver Research and Clinical Management

8. Summary

Ramesh K. Batra\* and David C. Mulligan

\*Address all correspondence to: drrkbatra@gmail.com

Section of Transplantation and Immunology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
