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Absolute lymphocyte count predictive of HCV recurrence post-liver transplant

Liver transplant recipients with HCV and lymphopenia had poorer survival and a greater risk for recurrence than patients with higher absolute lymphocyte counts in a recent study.

Researchers evaluated the absolute lymphocyte counts (ALCs) of 289 patients with HCV who underwent liver transplantation (LT) between 2005 and 2011, including ALC before transplantation and 2 weeks and 1 month post-LT, with follow-up across a median of 2.8 years. Patients were stratified according to ALC: below 500/mcL, 500 to 1,000/mcL and more than 1,000/mcL.

HCV recurrence with fibrosis of stage F2-4 occurred in 49.5% of the cohort within a median of 10.8 months. Recurrence rates at 1 year were significantly greater with lower ALC pretransplant (54% for below 500/mcL, 31% for 500-1,000/mcL and 20% for more than 1,000/mcL; P=.007) and at 1 month post-LT (39%, 28% and 18%, respectively; P=.004). Multivariate analysis indicated that low ALC at 1 month was independently predictive of recurrence (HR=2.47; 95% CI, 1.16-5.28 for below 500/mcL; HR=1.97; 95% CI, 1.07-3.62 for 500-1,000/mcL), while pretransplant ALC was not.

Patients with early advanced fibrosis (stage F3-4 within 2 years) had significantly lower ALC than those who did not at all evaluated time points. Investigators noted an independent association between risk for early advanced fibrosis and persistent lymphopenia (HR=3.16; 95% CI, 1.17-8.55).

Overall survival was 90.5% at 1 year, 85% at 2 years and 80.2% at 3 years. Survival at 1 and 3 years was lower in those with ALC below 500/mcL compared with more than 1,000/mcL (P=.001). Multivariate analysis indicated that ALC below 500 mc/L was independently predictive of mortality (HR=3.01; 95% CI, 1.55-5.86).

“Peritransplant ALC can be a useful surrogate marker for prediction of HCV recurrence and survival,” the researchers concluded. “Maintaining peritransplant ALC could lead to improved HCV outcome following LT. Since ALC is easily measured without additional effort or cost, this laboratory test can be useful not only for transplant physicians and surgeons but also primary care doctors in daily clinical settings.”

Disclosure: The researchers report no relevant financial disclosures.