Recognizing dysfunctional innate and adaptive immune responses contributing to liver damage in patients with cirrhosis.

The human host immune system wards off attack by enemy such as viruses by mounting an inflammatory response which may sometimes injure self-tissues. Dysfunctional immune/inflammatory response by the host may affect the functioning of vital organs. The largest number of innate immune cells in the body resides in the liver. On encountering a new insult or injury to the liver, the innate immune system responds quickly to counter it. Acute liver insults may trigger acute liver failure or acute on chronic liver failure, these disorders are associated with predominant innate immune response. Activation of reticulo-endothelial system (part of innate immune response) predicts short term and medium term survival in patients with acute on chronic liver failure. Liver diseases associated with aberrant adaptive immune response like autoimmune hepatitis respond well to treatment with steroids and other immunosuppressants, while those associated with innate immune dysfunction like acute on chronic liver failure do not respond well to steroids; recent reports suggest that the latter disorders may respond to therapeutic plasma exchange. How does the immune system in a patient with liver disease respond to SARS CoV2 infection? While commonly used tests in routine clinical practice provide clues to activation of different arms of immune response in patients with cirrhosis, specialized tests may help characterize this further. This review discusses the tests which reflect aberrant immune responses in patients with cirrhosis and treatment of the same.