Angele M K, Loehe F, Faist E
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.
Minerva Pediatr. 2005 Oct;57(5):259-68.
Newer immunosuppressive agents have dramatically reduced the rates of acute graft rejection over the last decade but may have exacerbated the problem of post-transplant infections. Causes of early mortality include graft dysfunction and sepsis. Late mortality occurs mainly due to sepsis. An excessive inflammatory response followed with a dramatic paralysis of cell-mediated immunity has been documented in septic patients. In transplanted individuals the pathophysiological changes of the immune response are further complicated by immunosuppressive agents. This article will focus on the effect of immunosuppressive agents and sepsis on cell-mediated immune responses. Moreover, potentially promising immunomodulatory approaches, i.e. human activated protein C, immunomodulatory diets containing L-arginine and fish oil, selective cytokine blockade, platelet-activating factor receptor antagonist, LPS receptor CD14 blockade and G-CSF, for the treatment of immunodysfunction in septic patients will be outlined in this review article. Most of them, however, have not been tested in the clinical arena in transplanted patients. Thus, the main part of the article, immunomodulation during sepsis in organ transplanted children is quite speculative and based on immunomodulatory strategies in other non-transplanted septic patients.
在过去十年中，新型免疫抑制剂显著降低了急性移植物排斥反应的发生率，但可能加剧了移植后感染问题。早期死亡原因包括移植物功能障碍和败血症。晚期死亡主要由败血症导致。脓毒症患者中已证实存在过度炎症反应，随后细胞介导的免疫出现严重麻痹。在移植个体中，免疫抑制药物使免疫反应的病理生理变化更加复杂。本文将重点关注免疫抑制药物和败血症对细胞介导免疫反应的影响。此外，本综述文章将概述一些潜在有前景的免疫调节方法，即人活化蛋白C、含L-精氨酸和鱼油的免疫调节饮食、选择性细胞因子阻断、血小板活化因子受体拮抗剂、LPS受体CD14阻断和粒细胞集落刺激因子，用于治疗脓毒症患者的免疫功能障碍。然而，其中大多数尚未在移植患者的临床领域进行测试。因此，本文的主要部分，即器官移植儿童脓毒症期间的免疫调节颇具推测性，是基于其他非移植脓毒症患者的免疫调节策略。
