Effects of laparoscopic splenectomy and azygoportal disconnection on immune remodeling in cirrhosis patients with portal hypertension bleeding: a 1-year prospective study.

AIM: This study aimed to characterize immune remodeling following laparoscopic splenectomy and azygoportal disconnection (LSD) in patients with cirrhotic portal hypertension. METHODS: In this 1-year prospective study, a total of 49 patients with cirrhotic portal hypertension received LSD treatment. We analyzed the dynamic changes in immune function-related indices through serial assessments conducted preoperatively and at 1, 3, 6, and 12 months postoperatively (POM 1, 3, 6, 12), specifically focusing on CD4+ T cell, CD8+ T cell, and CD19+.CD20+ B cell. RESULTS: Postoperative immune function was remodeled: the relative count of CD4⁺ T cells decreased progressively from 59.13% (53.49%, 69.40%) preoperatively to 43.00% (40.76%, 47.63%) at POM 12, a significant decline of 27.28% (P < 0.001). The relative count of CD8⁺ T cells increased progressively from 29.66% (22.25%, 34.47%) preoperatively to 46.00% (39.47%, 50.52%) at POM 12, a significant rise of 55.09% (P < 0.001). The CD4⁺/CD8⁺ T cell ratio decreased from 2.44 ± 1.19 preoperatively to 1.03 ± 0.51 at POM 12, a significant reduction of 57.79% (P < 0.001). The relative count of CD19⁺/CD20⁺ B cells declined from 19.61 ± 9.44% preoperatively to 10.09 ± 4.33% at POM 12, a significant decrease of 48.55% (P < 0.001). Statistically significant differences were observed in all four immune parameters when comparing preoperative levels with those at POM 1, 3, 6, and 12 (all P < 0.001). CONCLUSION: LSD effectively changes peripheral immune profiles associated with cirrhotic portal hypertension.