Mechanisms, clinical translation, and future perspectives of liver-mediated immunoprotection in combined organ transplantation

Table 1 Comparison of conventional liver-containing multivisceral transplantation and modified liver-sparing multivisceral transplantation

Feature	Conventional liver-containing MVT	Modified liver-sparing MVT
Immunoprotective effect	+++ (with liver-mediated immunoprotection)	- (absent)
Risk of rejection	Lower	Higher
Requirement for donor liver	Required	Not required
Main indications	Intestinal failure with end-stage liver disease	Intestinal failure with preserved liver function
Intensity of immunosuppression	May be moderately reduced	High-intensity immunosuppression generally required
Ref.	[27]	[24,28]

MVT: Multivisceral transplantation.

Table 2 Summary of key clinical outcomes in liver-containing combined intestinal/multivisceral transplantation

Ref.	n	Follow-up	Patient survival	Graft survival	Acute rejection	GVHD
Abu-Elmagd et al[27]	500	Up to 15 years	85% (1-year), 61% (5-year), 42% (10-year)	80% (1-year), 50% (5-year), 33% (10-year)	NR	NR
Tzakis et al[16]	100	Median 5.2 years	72% (1-year), 58% (5-year)	68% (1-year), 52% (5-year)	17% (MVT)	13%
Zheng et al[8]	98	Median 37.5 months	65% (1-year), 49% (3-year), 49% (5-year)	63% (1-year), 47% (3-year), 47% (5-year)	31.6% (moderate-severe, era 3)	NR
Ruart et al[10]	100	Median 25 months	72% (1-year), 57% (3-year)	NR	17% (MVT), 50% (MMVT)	13%

GVHD: Graft-vs-host disease; NR: Not reported; MVT: Multivisceral transplantation; MMVT: Modified multivisceral transplantation; OPTN/SRTR: Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients.