Spleen-liver axis: An emerging framework for immunometabolic interactions across sepsis, cancer, metabolism and transplantation

Key Takeaways for GI Nurses

• This review highlights the spleen-liver axis as an emerging physiological concept describing how splenic and hepatic immune and metabolic functions interact—relevant knowledge for nurses caring for patients with cirrhosis, portal hypertension, sepsis, or post-transplant status.
• Patients with chronic liver disease often have coexisting splenic changes (splenomegaly, hypersplenism) that affect platelet counts and bleeding risk—important considerations when prepping patients for endoscopic procedures such as variceal banding or EGD with biopsy.
• Understanding that the spleen and liver communicate immunologically reinforces why GI patients with liver disease may present with altered infection risk, inflammatory markers, or unpredictable responses to procedural stress, including sepsis.
• This is a conceptual/mechanistic review rather than a new clinical guideline or regulatory mandate; nurses should view it as background science that may eventually inform risk stratification tools rather than an immediate practice change.

Clinical Relevance

For endoscopy and GI nurses, much of our daily focus is procedural—prepping patients, monitoring sedation, assessing post-procedure recovery—but the physiological context behind our patients' underlying disease states shapes how we interpret their clinical presentation. The spleen-liver axis concept described in this review offers a framework for understanding why patients with cirrhosis or portal hypertension often have complex, interrelated lab abnormalities (thrombocytopenia from splenic sequestration, altered immune markers, metabolic derangements) that go beyond isolated liver dysfunction. Recognizing this interconnectedness can help nurses better anticipate complications such as bleeding tendencies, delayed wound healing, or atypical infectious presentations in this population.

This is particularly relevant in units that regularly perform procedures on patients with known hepatosplenic disease—variceal screening and banding, paracentesis-adjacent care, or endoscopic evaluation prior to liver transplant workup. Patients with cirrhosis frequently have splenomegaly and hypersplenism, and nurses should remain vigilant for thrombocytopenia-related bleeding risk and signs of subclinical infection, given the immune dysregulation described in conditions linking spleen and liver function. Additionally, transplant and oncology patients undergoing GI procedures may have had prior splenectomy or splenic involvement from malignancy, altering their baseline immune competence and infection risk during and after endoscopy.

From a professional development standpoint, staying current with emerging pathophysiology—even when not imm