title: Absolute lymphocyte count recovery at 1 month after transplantation predicts favorable outcomes of patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Absolute lymphocyte count (ALC) and the recovery of ALC after treatment have been identified as a prognostic biomarker for several malignancies. In this study, we aimed to investigate the prognostic role of peritransplant ALC and ALC recovery after liver transplantation (LT) in hepatocellular carcinoma (HCC) patients.
  
  
  METHODS
  A total of 269 HCC patients undergoing LT were enrolled in our study. Clinicopathological data were retrospectively collected and reviewed. Peritransplant ALC and the change of ALC (2 weeks, 1 month, 3 months post-LT) were carefully monitored. All potential risk factors were analyzed by univariate and multivariate cox regression analysis.
  
  
  RESULTS
  Over a mean follow-up of 35.9 months, 120 recurrences and 89 deaths were recorded. In the multivariate analysis, HCC with ALC no recovery at 1 month after LT (P < 0.001), high pretransplant alpha fetoprotein (P = 0.010), total tumor size > 8 cm (P = 0.003), and beyond Milan criteria (P < 0.001) were four independent risk factors for HCC recurrence. For overall survival (OS) after LT, ALC no recovery at 1 month after LT (P = 0.003), total tumor size > 8 cm (P = 0.011), pretransplant albumin < 2.8 g/dL (P = 0.049), model of end-stage liver disease score > 15 (P = 0.017), and beyond Milan criteria (P = 0.001) were significantly related to poor OS. When subgroup analyses were performed according to the Milan criteria, the results showed that the recovery of ALC at 1 month after LT still indicated longer recurrence-free survival (RFS) (P < 0.001) and OS (P = 0.005) beyond Milan criteria as well as RFS (P < 0.001) within Milan criteria, but not OS (P = 0.157) within Milan criteria.
  
  
  CONCLUSIONS
  ALC recovery at 1 month after LT indicated favorable outcomes of HCC patients.
authors.affiliation: Key Lab of Multi-Organ Transplantation, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China; Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Zhiyun
authors.initials: Z
authors.lastname: Zheng
authors.forename: Bingyi
authors.initials: B
authors.lastname: Lin
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.forename: Zhe
authors.initials: Z
authors.lastname: Yang
authors.forename: Haiyang
authors.initials: H
authors.lastname: Xie
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: absolute lymphocyte count recovery; hepatocellular carcinoma; liver transplantation; prognosis