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The ultimate goal in organ transplantation is to produce immunological tolerance so that the patient is specifically rendered incapable of reaction against the organ in question but is not otherwise immunologically paralysed. To do this without the use of poisonous immunosuppresive drugs would certainly be preferable, but for the moment it is likely that the only way in which we can achieve this goal in the short term is by a preliminary conditioning period using the agents that we already have and those that are likely soon to become available. Despite chemical immunosuppressive drugs having been available for 30 years it is still not clear exactly how they should be used, although it is apparent that the dose must be tailored individually for each patient in question. We know that there are natural inhibitory control mechanisms of the immune system, and it is likely that in our approach to immunosuppression we are not able to take account of natural controls and probably destroy suppressor mechanisms in the course of our therapy. Probably the requirements of immunosuppression vary at different stages in relation to the timing of the transplant and the reaction to it.
KeywordsLiver Transplantation Primary Biliary Cirrhosis Biliary Atresia Liver Graft Primary Pulmonary Hypertension
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