CD4+CD25+ regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy

Wei Wang; Chun-Hui Ye; Zhen-Feng Deng; Ji-Long Wang; Ling Zhang; Li Bao; Bang-Hao Xu; Hai Zhu; Ya Guo; Zhang Wen

doi:10.4240/wjgs.v15.i5.917

CD4⁺CD25⁺ regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy

World J Gastrointest Surg. 2023 May 27;15(5):917-930. doi: 10.4240/wjgs.v15.i5.917.

Authors

Wei Wang^{1

2}, Chun-Hui Ye^{1

2}, Zhen-Feng Deng^{1

2}, Ji-Long Wang^{1

2}, Ling Zhang³, Li Bao⁴, Bang-Hao Xu^{1

2}, Hai Zhu^{1

2}, Ya Guo^{1

2}, Zhang Wen^{1

5}

Affiliations

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
² Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
³ Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
⁴ Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300000, China.
⁵ Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China. wenzgxmu@163.com.

Abstract

Background: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an innovative surgical approach for the treatment of massive hepatocellular carcinoma (HCC), the key to successful planned stage 2 ALPPS is future liver remnant (FLR) volume growth, but the exact mechanism has not been elucidated. The correlation between regulatory T cells (Tregs) and postoperative FLR regeneration has not been reported.

Aim: To investigate the effect of CD4⁺CD25⁺ Tregs on FLR regeneration after ALPPS.

Methods: Clinical data and specimens were collected from 37 patients who developed massive HCC treated with ALPPS. Flow cytometry was performed to detect changes in the proportion of CD4⁺CD25⁺ Tregs to CD4⁺ T cells in peripheral blood before and after ALPPS. To analyze the relationship between peripheral blood CD4⁺CD25⁺ Treg proportion and clinicopathological information and liver volume.

Results: The postoperative CD4⁺CD25⁺ Treg proportion in stage 1 ALPPS was negatively correlated with the amount of proliferation volume, proliferation rate, and kinetic growth rate (KGR) of the FLR after stage 1 ALPPS. Patients with low Treg proportion had significantly higher KGR than those with high Treg proportion (P = 0.006); patients with high Treg proportion had more severe postoperative pathological liver fibrosis than those with low Treg proportion (P = 0.043). The area under the receiver operating characteristic curve between the percentage of Tregs and proliferation volume, proliferation rate, and KGR were all greater than 0.70.

Conclusion: CD4⁺CD25⁺ Tregs in the peripheral blood of patients with massive HCC at stage 1 ALPPS were negatively correlated with indicators of FLR regeneration after stage 1 ALPPS and may influence the degree of fibrosis in patients' livers. Treg percentage was highly accurate in predicting the FLR regeneration after stage 1 ALPPS.

Keywords: Associating liver partition and portal vein ligation for staged hepatectomy; Future liver remnant; Regulatory T cells.