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Background  T cells and B cells play a key role in alloimmune responses. We aimed to characterize the shift of T cell subsets and B cell subsets during acute hepatic rejection, and further determine whether they could serve as a prognostic marker.    Methods  Blood samples together with the clinical data from liver transplant recipients with and without acute hepatic rejection were collected and analyzed as well as from a validation cohort.    Results  Upon activation the expression of TGF-β and granzyme B in CD19 + B cells, and the expression of IL-2 and IFN-γ in CD4 + T cells were higher in acute hepatic rejection. However, only the frequencies of granzyme B + CD19 + B cells and IFN-γ + CD4 + T cells correlated with liver function in addition to with each other. A combination of the two cell subsets as a novel marker could classify rejection versus non-rejection (area under the curve 0.811, p = 0.001) with the cut-off value of 62.93%, which was more sensitive for worse histological changes (p = 0.027). Moreover, the occurrence rate of acute rejection was higher in the group with the novel marker > 62.93% (p = 0.000). The role of the novel marker was further confirmed in a validation cohort, which was identified to be the only significant independent risk factor for acute rejection (odds ratio: 0.923; 95% CI confidence interval: 0.885–0.964; p = 0.000).    Conclusions  A combination of the percentages of IFN-γ + CD4 + T cells and granzyme B + CD19 + B cells can distinguish rejection from non-rejection, which can be used as a potential prognostic marker for acute rejection in liver transplant recipients.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12967-021-02855-w.

A combination of the percentages of IFN-γ+CD4+T cells and granzyme B+CD19+B cells is associated with acute hepatic rejection: a case control study