[Cirrhosis-associated immune dysfunction (CAID)]

Liver cirrhosis is considered as a multisystemic disease that affects also the immune system. The spectrum of immunological alterations that can be found in patients with liver cirrhosis is summarized as cirrhosis-associated immune dysfunction (CAID). The mechanisms that are involved in the development of CAID are complex. Next to immune-mediated mechanisms causing the development of liver cirrhosis, one of the key mechanisms in the development of CAID is portal hypertension, leading to an impaired gut-liver-axis with an increased bacterial translocation to the blood stream. CAID can be assigned in the two key components systemic inflammation and immune deficiency. The intensity of components is variable and dynamic and depends on the stage of liver cirrhosis as well as the presence of incidental events (e.g. bacterial infections). In return, CAID increases the risk of infections and worsens the prognosis of the patient. The reduction of portal hypertension, inter alia by the insertion of a transjugular intrahepatic portosystemic shunt seems to be an important approach in the modulation of CAID. Further therapeutic approaches include the reduction of bacterial components to the blood and the modulation of impaired immune cell functions. Nevertheless, the only targeting approach of liver cirrhosis and CAID is still liver transplantation.