Pretransplant Lymphocyte Count Predicts the Incidence of Infection During the First Two Years After Liver Transplantation

Patients with end-stage liver disease (ESLD) show a low absolute number of peripheral blood lymphocyte subpopulations (PBLSs). We investigated if the baseline PBLS could categorize orthotopic liver transplantation (OLT) recipients into groups at high or low risk for infection after transplantation. PBLSs were prospectively studied in 63 consecutive patients (42 males; mean age +/- standard deviation: 53.5 +/- 10.3 years) with ESLD prior to OLT. Thirty-five patients (55.6%) developed a total of 79 infectious episodes during the first 2 years post-OLT. The median total lymphocyte count and PBLS levels [CD3(+) T cells, CD4(+) T cells, memory (CD45RO(+)) CD4(+) T cells, T cell receptor alpha beta(+) and gamma beta(+) subsets, and CD19(+) B cells] at baseline were significantly lower in patients with an infection compared with those without one (P < 0.05). There was a significant correlation between the risk of development of a post-OLT infection and a baseline total lymphocyte count < 1.00 X 10(3)/mu L (P = 0.001), a baseline CD3(+) T cell count < 0.75 X 10(3)/mu L (P = 0.009), and a baseline CD4(+) T cell count < 0.5 X 10(3)/mu L (P = 0.008). In the multivariate analysis, this association between the baseline total lymphocyte level and infection remained significant (odds ratio: 10.1; 95% confidence interval: 1.9-39.5). In conclusion, the pre-OLT total lymphocyte count identifies a subset of patients at high risk for infection. PBLS monitoring prior to OLT may offer an opportunity for surveillance, tapering of immunosuppression, and preemptive therapy. Liver Transpl 15:1209-1216, 2009. (C) 2009 AASLD.