title: Peritransplant absolute lymphocyte count as a predictive factor for advanced recurrence of hepatitis C after liver transplantation.
abstract: Lymphocytes play an active role in natural immunity against hepatitis C virus (HCV). We hypothesized that a lower absolute lymphocyte count (ALC) may alter HCV outcome after liver transplantation (LT). The aim of this study was to investigate the impact of peritransplant ALC on HCV recurrence following LT. A total of 289 LT patients between 2005 and 2011 were evaluated. Peritransplant ALC (pre-LT, 2-week, and 1-month post-LT) and immunosuppression were analyzed along with recipient and donor factors in order to determine risk factors for HCV recurrence based on METAVIR fibrosis score. When stratifying patients according to pre- and post-LT ALC (<500/μL versus 500-1,000/μL versus >1,000/μL), lymphopenia was significantly associated with higher rates of HCV recurrence with fibrosis (F2-4). Multivariate Cox regression analysis showed posttransplant ALC at 1 month remained an independent predictive factor for recurrence (P = 0.02, hazard ratio [HR] = 2.47 for <500/μL). When peritransplant ALC was persistently low (<500/μL pre-LT, 2-week, and 1-month post-LT), patients were at significant risk of developing early advanced fibrosis secondary to HCV recurrence (F3-4 within 2 years) (P = 0.02, HR = 3.16). Furthermore, severe pretransplant lymphopenia (<500/μL) was an independent prognostic factor for overall survival (P = 0.01, HR = 3.01). The use of rabbit anti-thymocyte globulin induction (RATG) had a remarkable protective effect on HCV recurrence (P = 0.02, HR = 0.6) despite its potential to induce lymphopenia. Subgroup analysis indicated that negative effects of posttransplant lymphopenia at 1 month (<1,000/μL) were significant regardless of RATG use and the protective effects of RATG were independent of posttransplant lymphopenia.
  
  
  CONCLUSIONS
  Peritransplant ALC is a novel and useful surrogate marker for prediction of HCV recurrence and patient survival. Immunosuppression protocols and peritransplant management should be scrutinized depending on peritransplant ALC.
authors.affiliation: Division of Transplant and Hepatobiliary Surgery, Henry Ford Transplant Institute, Henry Ford Hospital, Detroit, MI.
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshida
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kohno
authors.forename: David
authors.initials: D
authors.lastname: Altshuler
authors.forename: Mio
authors.initials: M
authors.lastname: Nakamura
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Brown
authors.forename: Marwan S
authors.initials: MS
authors.lastname: Abouljoud
authors.forename: Dilip
authors.initials: D
authors.lastname: Moonka
mesh_terms: D000818:Animals; D000961:Antilymphocyte Serum / Q000494:pharmacology; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology*; D016031:Liver Transplantation; D018655:Lymphocyte Count; D008231:Lymphopenia / Q000150:complications; D008297:Male; D008824:Michigan / Q000453:epidemiology; D059035:Perioperative Period; D011183:Postoperative Complications / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D011817:Rabbits; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load / Q000187:drug effects
chemical_list: D000961:Antilymphocyte Serum; D000998:Antiviral Agents