Pre-Transplant Lymphopenia and Early Severe Recurrence of Hepatitis C Disease After Liver Transplantation.
Recurrence of hepatitis C viral infection (HCV) after orthotopic liver transplantation
(OLT) is nearly universal; however, some patients recur at a much faster rate than
others. Low lymphocyte count has been postulated to be a possible surrogate marker for
infection risk after liver transplant and for severe early recurrence of HCV after OLT.
We hypothesized that pre-transplant ... read morelymphopenia is associated with early severe
recurrence of hepatitis C after liver transplant. We aimed to evaluate whether
pre-transplant lymphopenia was an independent predictor of early severe recurrence of
hepatitis C after liver transplant. Retrospective cohort study of 120 liver transplants
performed at Tufts Medical Center between 1999-2009. Cox proportional hazards regression
analysis was used to examine the association between early severe recurrence of
hepatitis C disease, lymphopenia and several other risk factors. The average age of the
study population was 51 years, 17% were female. Of these, 25% had a pre-transplant ALC
< 500/ul and 56% <1000/ul. Forty two percent of the 120 patients developed
fibrosis > 2 within 2 years of liver transplant. In univariate analyses,
pre-transplant ALC <500/ul was significantly associated with a reduced rate of early
severe recurrence of HCV (HR= 0.41, 95% CI 0.18-0.91). After multivariable adjustment,
pre-transplant ALC <500/ul had a significant protective effect against recurrence (HR
0.40, 95% CI 0.18-0.90). Those transplanted between 1999-2003 (HR = 0.51,95%CI
0.29-0.91) were less likely to have developed early recurrence. Being at increased risk
for CMV (CMV IgG recipient or donor positive) was associated with an increased risk of
recurrence (HR=2.50, 95%CI 1.16-5.40). Pre-transplant lymphopenia (pre-transplant ALC
<500/ul) was an independent predictor of protection against early severe recurrence
of hepatitis C after liver transplant. Low pre-transplant lymphocyte counts may reduce
preservation/reperfusion injury which has been associated with progressive fibrosis
after transplantation for HCV. Clinicians should be aware that higher pre-transplant
lymphocyte counts may result in early HCV related fibrosis and consider such patients
for anti-HCV therapy pre or early
Thesis (M.S.)--Tufts University, 2014.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: David Snydman.
Committee: Lori Lyn Price, Jessica Paulus, and Jennifer Chow.
Keyword: Medicine.read less