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BACKGROUND Patients with acute-on-chronic liver failure (ACLF) experience severe immune dysfunction. Liver transplantation (LT) significantly improves survival outcomes. However, the characteristics of peripheral blood lymphocyte subsets (PBLSs) in this patient population are not well defined, and the dynamics of immune reconstitution post-LT are insufficiently understood. AIM To characterize PBLSs in patients with ACLF prior to LT and to evaluate PBLS reconstitution after LT. METHODS Clinical data from patients undergoing LT in the Transplantation Center, The Third Xiangya Hospital from January 2022 to December 2023 were analyzed retrospectively. Our cohort comprised 44 patients with ACLF, 16 patients with acute decompensation of cirrhosis, and 23 patients with compensated cirrhosis. Twenty healthy volunteers were included as controls. PBLSs were evaluated across all groups. The relationship between PBLSs and post-LT prognosis was assessed, and dynamic changes in PBLSs among patients with ACLF were analyzed at different time points. RESULTS Patients with ACLF exhibited a marked reduction in PBLSs compared with healthy volunteers. Natural killer (NK) cell counts were further reduced in patients with ACLF when compared with patients with compensated cirrhosis. PBLSs did not correlate with the etiology or severity of ACLF or with established liver failure scores. Following LT, a rapid restoration of NK cells and B cells was observed in patients with ACLF. However, the cluster of differentiation (CD) 3+ T cell and CD4+ T cell counts decreased 14 days post-LT and subsequently returned to preoperative levels by day 21. CONCLUSION Patients with ACLF exhibited markedly reduced PBLSs, with decreased NK cells potentially linked to progression from compensated cirrhosis to liver failure. NK and B cell were rapidly restored after LT.
Peng et al. (2025) studied this question.