El-Bendary Mahmoud, Naemattalah Mustafa, Yassen Ahmed, Mousa Naser, Elhammady Dina, Sultan Ahmed M, Abdel-Wahab Mohamed
Department of Tropical Medicine and Hepatology, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt.
Department of Medical Biochemistry, Faculty of Medicine, Mansoura University, Mansoura 35111, Egypt.
World J Transplant. 2020 Jun 29;10(6):162-172. doi: 10.5500/wjt.v10.i6.162.
Early microbial recognition by the innate immune system is accomplished by Toll-like receptors (TLRs), with resultant initiation of a pro-inflammatory response against infecting organisms. In spite of presence of an abundance of Toll-like receptors on the surface of the liver, gut bacteria does not elicit an inflammatory reaction in healthy individuals due to tolerance to these TLRs, suggesting that the inflammatory responses seen in the liver are the result of breakdown of this tolerance. While orthotopic liver transplantation is often life saving in many instances, death following this procedure is most commonly due to infection that occurs in up to 80% of transplant recipients, most commonly due to microbial causes in up to 70% of cases and viral infections in 20%, while fungal infections affect only 8% of cases. The probability of acquiring infection following hepatic transplantation is heightened due to affection of the innate immune defense mechanisms of the host following this procedure. Single nucleotide polymorphisms of TLRs have been associated with increased likelihood of either development of post-transplant infection or eradication of infecting organism. However, conflicting reports from other studies reveal that prevalence of this single nucleotide polymorphism is not increased in infected patients.
先天性免疫系统对微生物的早期识别是通过Toll样受体（TLR）来完成的，从而引发针对感染生物体的促炎反应。尽管肝脏表面存在大量的Toll样受体，但由于对这些TLR具有耐受性，肠道细菌在健康个体中不会引发炎症反应，这表明在肝脏中看到的炎症反应是这种耐受性破坏的结果。虽然原位肝移植在许多情况下往往能挽救生命，但该手术后的死亡最常见的原因是感染，高达80%的移植受者会发生感染，其中多达70%的病例最常见的是微生物感染，20%是病毒感染，而真菌感染仅影响8%的病例。肝移植后感染的可能性因该手术对宿主先天性免疫防御机制的影响而增加。Toll样受体的单核苷酸多态性与移植后感染的发生或感染生物体的清除可能性增加有关。然而，其他研究的相互矛盾的报告显示，感染患者中这种单核苷酸多态性的患病率并未增加。
