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. Conclusion: 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. (Hepatology 2014;58:35–45)

Perioperative changes in nutritional parameters and impact of graft size in patients undergoing adult living donor liver transplantation

“…In the present study, the TLC level showed a prolonged decline during the initial posttransplant catabolic phase, presumably as a result of immunosuppressive therapy, and this may indicate the importance of an early, immunomodulating enteral diet. Then, TLC gradually improved in parallel with an increase in lymphocyte proliferation upon recovery from protein‐energy malnutrition and tapering of the immunosuppressive therapy . The comparatively suppressed TLC in ABO‐incompatible recipients during the first 3 weeks after transplantation might be attributable to the addition of immunosuppressants such as rituximab approximately 2 weeks before LT and complete B‐cell elimination approximately 3 weeks after administration …”

“…Therefore, the instigation of specialized nutritional status measurements and interventions is required. Derangements of various serum biochemical nutritional parameters such as zinc, prealbumin, branched‐chain amino acids (BCAA), tyrosine, and total lymphocyte count (TLC) and related metabolic parameters such as the BCAA to tyrosine ratio (BTR) and ammonia are not uncommon in these patients as a result of the debilitating hepatic pathology and its medical management . These parameters could be good indicators of nutritional/metabolic status trends after LT.…”

Liver alone or simultaneous liver-kidney transplant? Pretransplant chronic kidney disease and post-transplant outcome - a retrospective study

“…Per our standard practice, rabbit anti‐thymocyte globulin (0.5 mg/kg, three doses) was used as our standard induction immunosuppression. An alternative regimen of basiliximab induction (20 mg, two doses) was used for select patients (select patients with liver cirrhosis secondary to hepatitis C infection) . Maintenance immunosuppression consisted of tacrolimus, mycophenolate mofetil, and steroids.…”

The predictive value of blood neutrophil-lymphocyte ratio in patients with end-stage liver cirrhosis following ABO-incompatible liver transplantation

“…demonstrated that the restoration of posttransplant absolute lymphocyte count can be a novel prognostic factor for the recurrence of hepatitis C and HCC. [910] Hellberg and Kδllskog previously revealed that neutrophil contributed to mediating postischemic kidney dysfunction. [11] Given this, the study was designed to determine the effect of presurgery blood parameters on outcomes of patients with ESLC after ABO-i LT.…”