Aim: Lymphocytes play an active role in immunity against HCV. The aim of this study was to investigate the impact of peri-transplant absolute lymphocyte counts (ALC) on HCV recurrence after liver transplant (LT).

Methods: 289 consecutive LT patients with HCV (2005-2011) were evaluated. The ALC pre-LT, at 2 weeks and at 1 month were analyzed along with recipient and donor factors and immunosuppression to determine risk factors for HCV replication and histologic recurrence defined as progression to F2-4 by METAVIR score.

Results: When stratifying patients according to peri-LT ALC, lymphopenia was significantly associated with higher rates of recurrence (F2-4).

Multivariate analysis showed a post-LT ALC<500/ΜL remained an independent predictive factor for F2-4 recurrence (HR=2.3; P=0.03), whereas rabbit anti-thymocyte globulin (RATG) induction had a protective effect (HR=0.6; P=0.02). Subanalysis indicated the negative effect of post-LT lymphopenia (<1,000/ΜL at 1 month) was significant regardless of RATG use.

HCV RNA levels at 2 months were significantly higher in the post-LT lymphopenia group (18,526,415 IU/mL vs. 3,932,466 IU/mL, P<0.001). When peri-LT ALC was persistently low (<500/ΜL), patients were at significant risk of developing early advanced fibrosis (F3-4 within 2y) (HR=3.0; P=0.03). Severe pre-LT lymphopenia (<500/ΜL) was an independent prognostic factor for overall survival (HR=3.0; P=0.01).

Conclusion: Peri-LT ALC can be a useful early marker to identify patients at risk for accelerated HCV recurrence, which may allow to optimize post-LT managements and to identify appropriate patients for anti-viral therapy.

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