To investigate the changes of T lymphocyte subset and its function in patients with chronic severe hepatitis or hepatocellular carcinoma(HCC) during the perioperation of liver transplantation.

Twenty patients who underwent orthotopic liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from September 2008 to July 2009 were enrolled in this prospective study. According to their primary disease, the patients were divided into 2 groups: SH group [patients with chronic severe hepatitis, n=10; 8 males and 2 females, mean age of (42±7) years old] and HCC group [patients with HCC, n=10; 9 males and 1 female, mean age of (47±7) years old]. Ten healthy volunteers received physical examination at the same period in the hospital were selected as the control group. The informed consents of all patients were obtained and the ethical committee approval was received. Patients in the SH group and HCC group were drawn blood sample at the time points of 30 min pre-transplantation, and 1, 3, 7, 14 d post-transplantation, while patients in the control group were taken blood sample when enrolled in the study. Parameters including percentage of T lymphocyte (T cell percentage), CD4⁺ CD25⁺ Foxp3⁺ regulatory T cell vs CD4⁺ lymphocyte (Treg percentage), Foxp3 mRNA level, IFN-γ and IL-4 level in peripheral blood were detected. The immunological detection indexes between two groups were compared using ANOVA analysis or t test.

Before the transplantation, T cell percentage and IFN-γ/IL-4 ratio in SH group were significantly lower, compared with that in the control group (LSD-t=4.431, 3.045; P<0.05), while Treg percentage and Foxp3 mRNA level raised significantly(LSD-t=5.667, 3.663; P<0.05). T cell percentage before transplantation in HCC group was significantly lower, compared with that in the control group (LSD-t=4.464, P<0.05), but there were no significant differences in Treg percentage, Foxp3 mRNA level and IFN-γ/IL-4 ratio between two groups (LSD-t=0.778, 1.010, 1.698; P>0.05). Treg percentage and Foxp3 mRNA level in SH group were both significantly higher than that in the HCC group(LSD-t=4.253, 3.117; P<0.05). T cell percentage in both groups significantly decreased on day 1 after operation, and began to increase on day 7 and recovered to the preoperative level on day 14 after operation. Treg percentage and Foxp3 mRNA level decreased gradually in SH group after operation, and the value on day 14 after operation was significantly lower than that of pre-transplantation (t=3.265, 2.842; P<0.05); Treg percentage and Foxp3 mRNA level also decreased in HCC group after transplantation, and Foxp3 mRNA level on day 14 after transplantation was significantly lower than that of pre-transplantation (t=2.580, P<0.05). Treg percentage and Foxp3 mRNA level in SH group were all significantly higher compared with those in HCC group at different time point after operation(P<0.05). IFN-γ/IL-4 ratio in SH group significantly increased on day 3 after operation, compared with that of pre-transplantation(t=2.261, P<0.05). There were no significant differences about IFN-γ/IL-4 ratio in HCC group between pre-transplantation and each time point after transplantation(P>0.05).

The immune status between patients with severe hepatitis and patients with hepatocelluar carcinoma are obviously different. Detecting the change of T lymphocyte subgroup and its function is helpful to determine the immune status of patients and to make individual immunosuppressant protocol.