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The unfinished legacy of liver transplantation: Emphasis on immunology

Starzl, TE and Lakkis, FG (2006) The unfinished legacy of liver transplantation: Emphasis on immunology. Hepatology, 43 (2 SUPP). ISSN 0270-9139

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Liver transplantation radically changed the philosophy of hepatology practice, enriched multiple areas of basic science, and had pervasive ripple effects in law, public policy, ethics, and theology. Why organ engraftment was feasible remained enigmatic, however, until the discovery in 1992 of donor leukocyte microchimerism in long-surviving liver, and other kinds of organ recipients. Following this discovery, the leukocyte chimerism-associated mechanisms were elucidated that directly linked organ and bone marrow transplantation and eventually clarified the relationship of transplantation immunology to the immunology of infections, neoplasms, and autoimmune disorders. We describe here how the initially controversial paradigm shift mandated revisions of cherished dogmas. With the fresh insight, the reasons for numerous inexplicable phenomena of transplantation either became obvious or have become susceptible to discriminate experimental testing. The therapeutic implications of the "new immunology" in hepatology and in other medical disciplines, have only begun to be explored. Apart from immunology, physiologic investigations of liver transplantation have resulted in the discovery of growth factors (beginning with insulin) that are involved in the regulation of liver size, ultrastructure, function, and the capacity for regeneration. Such studies have partially explained functional and hormonal relationships of different abdominal organs, and ultimately they led to the cure or palliation by liver transplantation of more than 2 dozen hepatic-based inborn errors of metabolism. Liver transplantation should not be viewed as a purely technologic achievement, but rather as a searchlight whose beams have penetrated the murky mist of the past, and continue to potentially illuminate the future. Copyright © 2006 by the American Association for the Study of Liver Diseases.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Starzl, TEtes11@pitt.eduTES11
Lakkis, FG
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 February 2006
Date Type: Publication
Journal or Publication Title: Hepatology
Volume: 43
Number: 2 SUPP
DOI or Unique Handle: 10.1002/hep.20959
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0270-9139
Article Type: Review
Other ID: uls-drl:31735062121276, Starzl CV No. 2217
Date Deposited: 08 Apr 2010 17:38
Last Modified: 16 Jul 2024 10:55


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