Absolute lymphocyte count recovery at 1 month after transplantation predicts favorable outcomes of patients with hepatocellular carcinoma.

Background and Aims 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. [ABSTRACT FROM AUTHOR]