title: Post-transplant persistent lymphopenia is a strong predictor of late survival in isolated intestine and multivisceral transplantation.
abstract: Absolute lymphocyte count (ALC) has been identified as a prognostic factor in liver transplantation. We hypothesized that a lower ALC may be linked to poor outcomes in isolated intestinal/multivisceral transplantation (IIT/MVT). The aim of this study was to investigate the prognostic impact of ALC in IIT/MVT. A total 141 IIT/MVT patients were eligible for the study. Post-transplant ALCs (at 3, 6, and 12 months) were evaluated, and prognostic impact of trend of ALC during the first year was investigated. Of these 141 patients, 108 patients survived in the first year (1-year survivors). One-year survivors were categorized according to post-transplant ALC at each time point. When ALC was decreased throughout the first year (post-transplant persistent lymphopenia: <500/μl at 3, 6, and 12 months), patient survival (P < 0.001, hazard ratio = 5.09) and graft survival (P < 0.001, hazard ratio = 5.15) after the first year was significantly worse, and this remained to be an independent risk factor. Negative impact of persistent lymphopenia on patient and graft survival was significant regardless of type of intestinal graft. Infection leading to mortality occurred more frequently in the persistent lymphopenia group (43% vs. 24%). Trend of post-transplant ALC may be a strong predictive marker for long-term outcome in 1-year survivors after IIT/MVT.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Mangus
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Eve
authors.initials: E
authors.lastname: Anderson
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Burcin
authors.initials: B
authors.lastname: Ekser
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Chandrashekhar A
authors.initials: CA
authors.lastname: Kubal
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Burch
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007239:Infections / Q000209:etiology / Q000401:mortality; D007422:Intestines / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D018655:Lymphocyte Count; D008231:Lymphopenia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013270:Stomach / Q000637:transplantation; D014781:Viscera / Q000637:transplantation*; D055815:Young Adult
keywords: absolute lymphocyte count; graft survival; infection; nutrition; patient survival