Phytohemagglutin-induced lymphocyte cytotoxicity in hemodialysis patients with hepatitis B virus infection.

Phytohemagglutinin (PHA)-induced or primary cytotoxicity in vitro which is mediated by T lymphocytes, was studied during hepatitis B virus (HBV) infection in 45 hemodialysis patients, and related to liver cell damage and recovery. HBsAg positive patients with raised transaminases had increased primary cytotoxicity similar to nine otherwise healthy subjects with acute hepatitis B. HBsAg positive patients with normal transaminases showed decreased primary cytotoxicity and recovered patients showed normal values. Increased primary cytotoxicity could not be attributed to an increase in T lymphocytes, as all groups of hemodialysis patients had decreased lymphocyte and T-lymphocyte counts without significant differences between them. In the follow-up study none of the 13 HBsAg positive patients with normal transaminases recovered. However, five of the 18 patients with raised transaminases did recover from hepatitis B, accompanied by a decrease in cytotoxicity. These results show that an increased PHA-induced lymphocyte cytotoxicity corresponds with the occurrence of liver cell damage and subsequent recovery in hemodialysis patients with HBV infection. This suggests that cytotoxic T lymphocytes are involved in liver cell damage and recovery in HBV infection.