Mallick Shweta, K N Anila, Sivaprasadan Saraswathy, S Sudhindran
Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India.
J Clin Exp Hepatol. 2023 Jul-Aug;13(4):682-690. doi: 10.1016/j.jceh.2022.10.012. Epub 2022 Nov 4.
Management of immunosuppression (IS) in liver transplant recipients in the setting of sepsis is an open stage for debate. The age-long practice of reduction or complete cessation of IS during sepsis has been followed by most centres across the world, although, their exact strategies are highly heterogeneous. On the other hand, the emergence of striking new evidence suggesting that there is, in fact, decreased mortality with the continuation of IS in sepsis, has raised doubts about our previously conceived intuitive notion that IS portends increased risk in sepsis. The theory postulated is that IS agents, perhaps reverse the state of dysregulated immune response in sepsis to that of an iatrogenically modulated immune response, thus dimming the inflammatory cascade and preventing its deleterious effects. Of note, none of these studies reported exaggerated rejection-related complications. These contrasting outlooks have made it rather onerous to formulate an evidence-based recommendation for liver transplant recipients afflicted with sepsis. Inclusion of transplanted patients in randomised controlled trials of sepsis-related interventions seems to be the need of the hour.
肝移植受者在脓毒症情况下免疫抑制（IS）的管理是一个有待讨论的开放阶段。全世界大多数中心都遵循了在脓毒症期间减少或完全停止IS这种由来已久的做法，尽管它们的确切策略高度不同。另一方面，新出现的显著证据表明，实际上在脓毒症期间继续进行IS可降低死亡率，这让我们对之前直观认为的IS会增加脓毒症风险的观念产生了怀疑。提出的理论是，免疫抑制剂可能将脓毒症中失调的免疫反应状态逆转至医源性调节的免疫反应状态，从而减弱炎症级联反应并防止其有害影响。值得注意的是，这些研究均未报告与排斥相关的并发症加剧情况。这些截然不同的观点使得为患有脓毒症的肝移植受者制定基于证据的建议变得相当困难。将移植患者纳入脓毒症相关干预措施的随机对照试验似乎是当务之急。
