Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Surg. Nov 27, 2026; 18(11): 124378
Published online Nov 27, 2026. doi: 10.4240/wjgs.124378
Published online Nov 27, 2026. doi: 10.4240/wjgs.124378
Mechanisms, clinical translation, and future perspectives of liver-mediated immunoprotection in combined organ transplantation
Zheng-Wei Zhao, Yu-Guo Chen, Guang-Yi Wang, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Co-corresponding authors: Yu-Guo Chen and Guang-Yi Wang.
Author contributions: Chen YG and Wang GY contributed equally to this manuscript and are co-corresponding authors. Zhao ZW and Chen YG wrote and edited the manuscript; Chen YG and Wang GY conceptualized the research topic and submitted the revised manuscript with all the related documents; and all authors thoroughly reviewed and endorsed the final manuscript.
AI contribution statement: Deepseek V3 was used for language polishing and literature review. The figure was generated by Gemini. AI tools were not involved in study design, data collection, or interpretation of results.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Guang-Yi Wang, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. guangyi@jlu.edu.cn
Received: June 12, 2026
Revised: July 6, 2026
Accepted: August 31, 2026
Published online: November 27, 2026
Processing time: 152 Days and 19.3 Hours
Revised: July 6, 2026
Accepted: August 31, 2026
Published online: November 27, 2026
Processing time: 152 Days and 19.3 Hours
Core Tip
Core Tip: This review highlights the immunoprotective mechanisms of the liver in combined intestinal and multivisceral transplantation, including liver sinusoidal endothelial cell-mediated antigen presentation, regulatory T cell enrichment, clonal deletion, and donor-specific antibody clearance. Concurrent liver inclusion reduces rejection rates but increases risks of graft-vs-host disease and infection. Normothermic machine perfusion and regulatory T-cell therapy represent promising strategies for optimizing immunomodulation.