Evaluation of Donor Specific Immune Senescence and Exhaustion as Biomarkers of Tolerance Post Liver Transplantation

Recipient participants who meet any of the following criteria will not be eligible for this study:

1. History of hepatitis C virus (HCV) infection (defined as a positive HCV antibody test).
2. Positive antigen-antibody immunoassay for human immunodeficiency virus, HIV-1/2.
3. Serum positivity for HBV surface antigen or HBV-DNA.
4. History of immune-mediated liver disease in which immunosuppression discontinuation is inadvisable (autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis).
5. Any medical condition associated with a likely need for systemic corticosteroid administration, e.g., reactive airways disease.
6. Prospective baseline liver biopsy showing any of the following: (see recipient inclusion criteria #4)
7. acute rejection according to the Banff global assessment criteria;
8. early or late chronic rejection according to the Banff global assessment criteria
9. inflammatory activity and/or fibrosis in excess of permissive criteria according to Banff 2012 criteria;
10. any other histological findings that might make participation in the trial unsafe. Eligibility will be determined by the findings on the central biopsy reading.
11. Rejection within the 52 weeks prior to screening.
12. Estimated glomerular filtration rate (GFR) <40 ml/min as calculated by CKD-EPI method(to mitigate the risk of worsening renal failure should rejection occur and high level of CNI be required).
13. The need for chronic anti-coagulation that cannot be safely discontinued for a minimum of 1 week to safely perform a liver biopsy.
14. . Pregnant females and females of childbearing age who are not using an effective method of birth control.
15. . Current drug or alcohol dependency.
16. . Inability to comply with the study visit schedule and required assessments, including frequent liver function monitoring and protocol biopsies.
17. . Inability to comply with study directed treatment.
18. . Any medical condition that in the opinion of the principal investigator would interfere with safe completion of the trial.
19. . Participation in another interventional clinical trial within the 4 weeks prior to screening.

Living donor participants who meet any of the following criteria will not be eligible for this study:

1. Any medical condition, such as anemia, coagulopathy, etc., that in the opinion of the principal investigator would interfere with safe participation in the trial.