Artificial liver support therapy alters TNFα and CD4+ T cell counts in liver failure: A pilot self-controlled study

Background: Artificial liver support therapy (ALS) is increasingly used in liver failure, but its immunomodulatory effects remain incompletely understood. This pilot study aimed to investigate changes in plasma cytokines and T lymphocyte subsets following ALS. Methods: Twenty-seven patients with liver failure who received ALS were enrolled. Plasma levels of TNFα, IL-4, IL-6, IL-10, IL-17, IL-2, and IFN-γ, as well as T lymphocyte subsets (CD4+ T cell absolute count, CD4+/CD8+ ratio), were measured before and after treatment. Paired t ‑tests were used for comparisons. Patients were dichotomized by median pre-treatment TNFα level to compare clinical outcomes. Results: After ALS, TNFα levels decreased significantly (2.537 ± 1.519 vs 1.522 ± 0.749 pg/mL, p = 0.004). IL-4 also showed a significant reduction (1.463 ± 1.165 vs 0.893 ± 0.648 pg/mL, p = 0.031). CD4+ T cell absolute count increased significantly (430.85 ± 220.15 vs 636.63 ± 429.27 cells/μL, p = 0.034). Total T cell count showed an increasing trend (788.70 vs 1093.63 cells/μL, p = 0.064). Patients with low pre-treatment TNFα levels (below median) had a significantly higher improvement rate compared to those with high TNFα levels (100% vs 71.4%, p = 0.036). Conclusion: ALS therapy is associated with a significant reduction in TNFα and a significant increase in CD4+ T cell absolute count, suggesting potential anti‑inflammatory and immune‑restorative effects. Lower baseline TNFα levels may predict favorable short‑term outcomes.