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

Background and Aims A bsolute 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 M ilan 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 M ilan criteria ( P  = 0.001) were significantly related to poor OS . When subgroup analyses were performed according to the M ilan 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 M ilan criteria as well as RFS ( P  < 0.001) within Milan criteria, but not OS ( P  = 0.157) within M ilan criteria. Conclusions ALC recovery at 1 month after LT indicated favorable outcomes of HCC patients.