title: Peritransplant lymphopenia is a novel prognostic factor in recurrence of hepatocellular carcinoma after liver transplantation.
abstract: BACKGROUND
  Absolute lymphocyte count (ALC) is considered a surrogate marker for the level of immunosuppression and nutritional status of patients and a prognostic factor for survival and recurrence in several cancers. The aim of this study was to investigate the prognostic value of peritransplant ALC for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT).
  
  
  METHODS
  HCC patients who underwent LT between 2000 and 2010 were evaluated. Exclusion criteria were combined HCC and cholangiocarcinoma. Peritransplant ALCs (before LT and 2 weeks and 1 month after LT) were analyzed along with tumor, operative, and donor characteristics to identify risk factors for the recurrence of HCC.
  
  
  RESULTS
  HCC developed in 27 of the 173 LT patients investigated for risk factors (15.6%). The median time to recurrence was 1.14 years. Low ALCs before and after LT were associated with a higher recurrence rate in a continuous manner (before LT: hazard ratio=1.12, P=0.003; 2 weeks after LT: hazard ratio=1.14, P=0.008; 1 month after LT: hazard ratio=1.06, P=0.055) (increased risk per 100/μL down). On multivariate Cox regression analysis, peritransplant persistent lymphopenia (<1000/μL before LT and <500/μL at 2 weeks and 1 month after LT) was an independent risk factor for cancer recurrence (hazard ratio=7.05, P<0.001), along with tumor characteristics.
  
  
  CONCLUSIONS
  Peritransplant lymphopenia is a powerful prognostic factor for the recurrence of HCC after LT, which suggests that maintaining ALCs in LT patients might improve cancer outcome.
authors.affiliation: 1 Division of Transplant and Hepatobiliary Surgery, Henry Ford Transplant Institute, Henry Ford Hospital, Detroit, Michigan. 2 Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan. 3 Address correspondence to: Atsushi Yoshida, M.D., F.A.C.S., 2799 W. Grand Blvd. CFP-2, Detroit, MI 48202.
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Marwan S
authors.initials: MS
authors.lastname: Abouljoud
authors.forename: Marwan
authors.initials: M
authors.lastname: Kazimi
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Brown
authors.forename: Dilip
authors.initials: D
authors.lastname: Moonka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshida
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D018655:Lymphocyte Count; D008231:Lymphopenia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome