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2017 ; 5
(1
): 50-58
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Immune Dysfunction in Cirrhosis
#MMPMID28507927
Noor MT
; Manoria P
J Clin Transl Hepatol
2017[Mar]; 5
(1
): 50-58
PMID28507927
show ga
Cirrhosis due to any etiology disrupts the homeostatic role of liver in the body.
Cirrhosis-associated immune dysfunction leads to alterations in both innate and
acquired immunity, due to defects in the local immunity of liver as well as in
systemic immunity. Cirrhosis-associated immune dysfunction is a dynamic
phenomenon, comprised of both increased systemic inflammation and
immunodeficiency, and is responsible for 30% mortality. It also plays an
important role in acute as well as chronic decompensation. Immune paralysis can
accompany it, which is characterized by increase in anti-inflammatory cytokines
and suppression of proinflammatory cytokines. There is also presence of increased
gut permeability, reduced gut motility and altered gut flora, all of which leads
to increased bacterial translocation. This increased bacterial translocation and
consequent endotoxemia leads to increased blood stream bacterial infections that
cause systemic inflammatory response syndrome, sepsis, multiorgan failure and
death. The gut microbiota of cirrhotic patients has more pathogenic microbes than
that of non-cirrhotic individuals, and this disturbs the homeostasis and favors
gut translocation. Prompt diagnosis and treatment of such infections are
necessary for better survival. We have reviewed the various mechanisms of immune
dysfunction and its consequences in cirrhosis. Recognizing the exact
pathophysiology of immune dysfunction will help treating clinicians in avoiding
its complications in their patients and can lead to newer therapeutic
interventions and reducing the morbidity and mortality rates.