Ischaemia-reperfusion injury in liver transplantation--from bench to bedside.
Ischaemia-reperfusion injury in liver transplantation--from bench to bedside.
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DOI：
10.1038/nrgastro.2012.225
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发表时间：
2013-02
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影响因子：
--
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中科院分区：
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--
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肝脏缺血再灌注损伤（ischaemia-reperfusioninjury，IRI）是失血性休克、肝切除和肝移植的主要并发症，是一个动态过程，包括局部缺血损伤和炎症介导的再灌注损伤两个相互关联的阶段。这篇综述强调了对先天适应性免疫串扰和细胞活化级联的最新机制见解，这些机制导致缺血再灌注应激肝脏中炎症介导的损伤，讨论了大型动物实验的进展，并研究了在接受肝移植的患者中尽量减少肝脏IRI的努力。相互联系的信号通路在多种肝细胞类型，IRI动力学和积极与消极的调节回路在先天适应性免疫界面进行了讨论。目前的差距，我们的知识和病理生理方面的IRI中，基础和转化研究仍然是必需的强调。提高对触发和维持局部炎症反应的细胞免疫事件的认识，这最终导致器官损伤，对于开发治疗接受肝移植并发生缺血再灌注炎症和器官功能障碍的患者的创新策略至关重要。
Ischaemia–reperfusion injury (IRI) in the liver, a major complication of haemorrhagic shock, resection and transplantation, is a dynamic process that involves the two interrelated phases of local ischaemic insult and inflammation-mediated reperfusion injury. This Review highlights the latest mechanistic insights into innate–adaptive immune crosstalk and cell activation cascades that lead to inflammation-mediated injury in livers stressed by ischaemia–reperfusion, discusses progress in large animal experiments and examines efforts to minimize liver IRI in patients who have received a liver transplant. The interlinked signalling pathways in multiple hepatic cell types, the IRI kinetics and positive versus negative regulatory loops at the innate–adaptive immune interface are discussed. The current gaps in our knowledge and the pathophysiology aspects of IRI in which basic and translational research is still required are stressed. An improved appreciation of cellular immune events that trigger and sustain local inflammatory responses, which are ultimately responsible for organ injury, is fundamental to developing innovative strategies for treating patients who have received a liver transplant and developed ischaemia–reperfusion inflammation and organ dysfunction.
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