title: Monitoring serial CD4⁺ T-cell function after liver transplantation can be used to predict hepatocellular carcinoma recurrence.
abstract: BACKGROUND
  After liver transplant (LT), the risk of hepatocellular carcinoma (HCC) recurrence is partially dependent on the degree of immunosuppression. We aimed to determine whether assessing net state of CD4(+) T-cell function after LT could determine those at risk for HCC recurrence.
  
  
  METHODS
  One hundred thirty-seven patients with cirrhosis who underwent LT for HCC were followed for recurrence of HCC. All patients had serial CD4(+) assay performed prospectively. Cox regression analysis was used to assess factors associated with HCC recurrence. Kaplan-Meier plots were used to assess the association between CD4(+) ATP values and hazard of HCC recurrence.
  
  
  RESULTS
  The mean follow-up time was 3.1 ± 1.5 years, during which 14 patients (10%) had HCC recurrence. Patients with combined post-LT CD4(+) T-cell function area under curve (AUC) <675 had 6.9 (95% CI 2.0-22.0) times greater hazard of HCC recurrence than those with CD4(+) T-cell function AUC ≥675 (P < .001). Less immunosuppression (ATP AUC ≥675) in those beyond Milan conferred a similar risk of recurrence as patients transplanted within Milan (P = .064).
  
  
  CONCLUSIONS
  Lower cumulative CD4(+) T-cell function post-LT predicted a higher risk of HCC recurrence. These findings may have implications toward management of HCC patients after LT.
authors: Departments of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, United States. Electronic address: Conferb@ccf.org.
authors: B D
authors: BD
authors: Confer
authors: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United States.
authors: M
authors: M
authors: Choudhary
authors: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States.
authors: R
authors: R
authors: Lopez
authors: Departments of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, United States.
authors: N N
authors: NN
authors: Zein
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D015496:CD4-Positive T-Lymphocytes / Q000502:physiology*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011237:Predictive Value of Tests; D012372:ROC Curve