Changes in peripheral T-lymphocyte subsets in acute-on-chronic liver failure patients with artificial liver support system.

BACKGROUND/AIMS: HBV-related acute-on-chronic liver failure (AoCLF) is associated with a high mortality rate. An artificial liver support system (ALSS) is a newly emerging therapeutic option, which can be implemented in routine patient care. In order to determine if any pretreatment immunological parameter could be an indicator to evaluate immune states for the outcome of the AoCLF patients, we analyzed the relationship between the level of T-lymphocyte subsets (CD4+, CD8+, CD4/CD8 ratio) and its therapeutic effect and prognosis. METHODOLOGY: Sixty-three patients with AoCLF were enrolled in 2 groups (ALSS plus routine-care, n=29 and routine-care only, n=34). In the ALSS group, there were 17 survivors (17/29), while in the routine-care group there were 11 survivors (11/34), both after 30 days of treatment. Twenty-three healthy donors were used as the control group. The number of CD4 and CD8 T cells was detected by flow cytometry and the ratio of CD4/ CD8 was calculated on admission and on days 7, 14, 21 and 30, during hospitalization. RESULTS: More dramatic increased CD4/CD8 ratio in the ALSS survivors (form 0.92±0.18 to 1.26±0.24, p<0.01) than the medical survivors (form 0.86±0.16 to 1.09±0.16, p<0.05) after 30 days of treatment. A declined tendency was observed in nonsurvivors. CONCLUSIONS: T-lymphocyte subsets may be important in the pathogenesis of the AoCLF and ALSS may represent a reliable hepatic support device for Ao- CLF.