Copyright
©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Peripheral blood lymphocyte subset deficiency in acute-on-chronic liver failure and reconstitution following liver transplantation
Bo Peng, Zhi-Xin Li, Min Yang, Kai Liu, Xu-Yu Xiang, Ying Zhang, Jun-Hui Li, Peng-Peng Zhang, Quan Zhuang, Ke Cheng, Ying-Zi Ming
Bo Peng, Min Yang, Kai Liu, Xu-Yu Xiang, Ying Zhang, Jun-Hui Li, Peng-Peng Zhang, Quan Zhuang, Ke Cheng, Ying-Zi Ming, Transplantation Center, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
Bo Peng, Min Yang, Kai Liu, Xu-Yu Xiang, Ying Zhang, Jun-Hui Li, Peng-Peng Zhang, Quan Zhuang, Ke Cheng, Ying-Zi Ming, Key Laboratory of Translational Research on Transplantation Medicine of National Health Commission, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
Zhi-Xin Li, Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
Co-first authors: Bo Peng and Zhi-Xin Li.
Author contributions: Peng B, Liu K, Xiang XY, Zhang Y, Li JH, and Zhang PP collected the data; Peng B and Li ZX performed the data analysis and prepared the manuscript; Li ZX generated the tables and figures; Zhuang Q and Cheng K revised the manuscript; Ming YZ conceptualized and supervised the study; The equal contribution of Peng B and Li ZX was critical to the study’s completion, meriting their designation as co-first authors; Peng B, Li ZX, Yang M, Liu K, Xiang XY, Zhang Y, Li JH, Zhang PP, Zhuang Q, Cheng K, Ming YZ read and agreed to the published version of the manuscript.
Supported by the National Natural Science Foundation of China, No. 82300857.
Institutional review board statement: The Institutional Review Board of The Third Xiangya Hospital, Central South University provided approval for this study (IRB No. Kuai24395).
Informed consent statement: The Institutional Review Board agreed to waive informed consent due to the research using human materials or data with unidentifiable personal information and not involving personal privacy or commercial interests.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: All data underlying this article are reported within and as online
Supplementary material.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ying-Zi Ming, Director, Professor, Transplantation Center, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha 410013, Hunan Province, China.
mingyz_china@csu.edu.cn
Received: July 24, 2025
Revised: August 26, 2025
Accepted: October 17, 2025
Published online: November 21, 2025
Processing time: 119 Days and 17 Hours
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.
Core Tip: Immune dysfunction is a hallmark characteristic of acute-on-chronic liver failure (ACLF). This study demonstrated that patients with ACLF exhibited a significant reduction in the level of peripheral blood lymphocyte subsets (PBLSs). Notably, natural killer (NK) cells may be associated with the progression of liver failure. Both NK and B cells have the potential to serve as biomarkers for immune recovery after liver transplantation. A thorough assessment of dynamic changes in PBLSs provided valuable insights into the evolving immune status of this population and supported the development of strategies for post-transplantation management.
