PRE-TRANSPLANT LYMPHOPENIA IS ASSOCIATED WITH SHORT-TERM MORTALITY AFTER DECEASED DONOR LIVER TRANSPLANTATION

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Hepatology

Abstract

Background: Absolute lymphocyte count (ALC) is considered a surrogate marker for nutritional status and immunocompetence. We investigated the association between ALC and post-liver transplant (LT) outcomes in patients who received a deceased donor LT (DDLT) at Henry Ford Hospital (HFH), and validated our results in a sample of patients from Toronto General Hospital (TGH). Methods: We reviewed medical records of adult patients who underwent primary LT from January 2013 through December 2018 at HFH. Patients who underwent re-transplant, living donor LT, split LT, and multi-organ transplant were excluded. Patients were categorized by pre-transplant ALC: low (<500/μL); mid (500-1000/ μL); and high ALC (>1000/μL). The association between ALC and 180-day post-transplant mortality was evaluated using Cox proportional hazards regression adjusted for clinically relevant factors. Next, the incidence rates of post-transplant complications within 180 days after LT were compared between groups. Finally, patients who survived for the first 30 days were dichotomized into those with and without persistent lymphopenia, and conditional 180-day survival (survival excluding the first 30 days after LT) was compared between the 2 groups. Our results were further validated using data from TGH. Results: Among 449 DDLT recipients who received DDLT at HFH, low ALC group demonstrated higher 180-day mortality than mid and high ALC groups (83.1% vs. 95.8% and 97.4%; low vs. mid: P=0.001, low vs. high: P<0.001, Figure 1A). A larger proportion of low ALC patients died of sepsis compared to mid/high groups (9.1% vs. 0.8%: P<0.001). In multivariable analysis, pre-transplant ALC was associated with 180-day mortality (HR 0.20; P=0.004). Low ALC patients had higher rates of bacteremia (22.7% vs. 8.1%: P<0.001) and CMV viremia (15.2% vs. 6.8%: P=0.03) than mid/high ALC patients. Low ALC pre-transplant through post-operative day 30 was associated with 180-day mortality among patients who received rabbit anti-thymocyte globulin induction (P=0.001, Figure 1B). Validation analysis demonstrated that pre-transplant and peri-transplant persistent lymphopenia were associated with worse 180-day patient survival after LT. Conclusion: Pre-transplant lymphopenia is associated with short-term mortality and a higher incidence of post-transplant bacteremia an CMV viremia in DDLT patients. Pre-transplant ALC may be a useful tool for identifying patients at high risk for adverse outcomes after DDLT. (Figure Presented).

Volume

76

First Page

S499

Last Page

S500

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