Zhang JW. Letter to the Editor: Induction immunotherapy in hyperimmunized liver transplantation: Rebalancing immunological risk and graft protection. World J Hepatol 2026; 18(8): 118687 [DOI: 10.4254/wjh.118687]
Corresponding Author of This Article
Jin-Wei Zhang, PhD, Principal Investigator, Professor, State Key Laboratory of Chemical Biology, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, No. 345 Lingling Road, Shanghai 200032, China. jinweizhang@sioc.ac.cn
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Biology
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letter
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Zhang JW. Letter to the Editor: Induction immunotherapy in hyperimmunized liver transplantation: Rebalancing immunological risk and graft protection. World J Hepatol 2026; 18(8): 118687 [DOI: 10.4254/wjh.118687]
World J Hepatol. Aug 27, 2026; 18(8): 118687 Published online Aug 27, 2026. doi: 10.4254/wjh.118687
Letter to the Editor: Induction immunotherapy in hyperimmunized liver transplantation: Rebalancing immunological risk and graft protection
Jin-Wei Zhang
Jin-Wei Zhang, State Key Laboratory of Chemical Biology, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, Shanghai 200032, China
Jin-Wei Zhang, Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter EX4 4PS, Devon, United Kingdom
Author contributions: Zhang JW designed the overall concept and outline of the manuscript, contributed to the discussion and design of the manuscript, contributed to the writing and editing of the manuscript, illustrations, and review of the literature.
Supported by National Natural Science Foundation of China, No. 82170406 and No. 81970238.
Conflict-of-interest statement: The author reported no relevant conflicts of interest for this article.
Corresponding author: Jin-Wei Zhang, PhD, Principal Investigator, Professor, State Key Laboratory of Chemical Biology, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, No. 345 Lingling Road, Shanghai 200032, China. jinweizhang@sioc.ac.cn
Received: January 12, 2026 Revised: March 27, 2026 Accepted: May 8, 2026 Published online: August 27, 2026 Processing time: 221 Days and 18.6 Hours
Abstract
Hyperimmunization-defined by the presence of pre-formed donor-specific antibodies or a positive donor–recipient crossmatch-remains a pivotal immunological challenge in liver transplantation (LT), linked to substantially elevated risks of acute rejection and graft dysfunction. In their recent work, EL-Domiaty et al published in the World Journal of Hepatology evaluate a targeted induction strategy combining rabbit anti-T-lymphocyte globulin and high-dose intravenous immunoglobulin in hyperimmunized liver transplant recipients. Using a rigorous matched case-control design, the team demonstrates that this induction approach yields rejection rates, graft survival, and patient outcomes on par with those seen in non-immunized recipients, with no excess of severe infectious complications. This editorial situates these valuable findings within the evolving body of literature on antibody-mediated injury in LT, offers a critical appraisal of the study’s methodology and real-world clinical implications, and explores how such induction strategies can shape the future of personalized immunosuppressive care for immunologically high-risk liver transplant patients.
Core Tip: For decades, hyperimmunized liver transplant recipients have faced poorer clinical outcomes due to their heightened immunological risk profile, leaving clinicians with limited evidence-based management options. This editorial delivers a comprehensive analysis of EL-Domiaty et al’s landmark study, which provides compelling clinical evidence that a short-course induction regimen of rabbit anti-T-lymphocyte globulin plus intravenous immunoglobulin can effectively mitigate early rejection risk and align outcomes with those of non-immunized recipients. This work highlights a viable, pragmatic strategy for managing this challenging patient population and paves the way for more personalized immunosuppression in liver transplantation.
