Weaning transplant recipients from their immunosuppressive drugs

Transplant surgeons live in the hope that one day they will be able to wean at least some of their patients off the immunosuppressive drugs that must be taken to prevent rejection of a transplanted organ. A team of researchers led by Alberto Sánchez-Fueyo, at the University of Barcelona, Spain, has now identified markers that might make this possible for liver transplant recipients.

Transplant recipients must take immunosuppressive drugs for the rest of their lives to prevent rejection of their transplanted organ; this has serious negative health consequences. It would be helpful if it were possible to determine what would happen if a patient was weaned from their immunosuppressive drugs: would they reject their transplanted organ or would their immune system be sufficiently tolerant of the transplant that it would not be rejected?

Sánchez-Fueyo and colleagues determined that liver transplant recipients with higher blood levels of proteins involved in handling iron (hepcidin and ferritin) could tolerate weaning from their immunosuppressive drugs. Moreover, measuring expression in the liver of genes involved in handling iron enabled Sánchez-Fueyo and colleagues to predict the outcome of immunosuppressive-drug withdrawal in an independent set of patients. They therefore suggest that they have identified a way to accurately pick out those liver transplant recipients who would be good candidates for drug-weaning protocols.