Monitoring Serial CD4+ T-Cell Function After Liver Transplantation Can Be Used to Predict Hepatocellular Carcinoma Recurrence

•Hepatocellular carcinoma recurrence following liver transplant has been associated with degree of immunosuppression when utilizing therapeutic drug monitoring•Utilization of an ATP immune function assay demonstrated that a lower cumulative CD4+ T-cell function following liver transplant predicts the patient population at highest risk for hepatocellular carcinoma recurrence•Patients transplanted outside of Milan criteria with higher cumulative CD4+ T cell function had similar risk for hepatocellular carcinoma recurrence following liver transplant as those patients transplanted within the Milan criteria

BackgroundAfter liver transplant (LT), the risk of hepatocellular carcinoma (HCC) recurrence is partially dependent on the degree of immunosuppression. We aimed to determine whether assessing net state of CD4+ T-cell function after LT could determine those at risk for HCC recurrence.MethodsOne hundred thirty-seven patients with cirrhosis who underwent LT for HCC were followed for recurrence of HCC. All patients had serial CD4+ assay performed prospectively. Cox regression analysis was used to assess factors associated with HCC recurrence. Kaplan-Meier plots were used to assess the association between CD4+ ATP values and hazard of HCC recurrence.ResultsThe mean follow-up time was 3.1 ± 1.5 years, during which 14 patients (10%) had HCC recurrence. Patients with combined post-LT CD4+ T-cell function area under curve (AUC) <675 had 6.9 (95% CI 2.0–22.0) times greater hazard of HCC recurrence than those with CD4+ T-cell function AUC ≥675 (P < .001). Less immunosuppression (ATP AUC ≥675) in those beyond Milan conferred a similar risk of recurrence as patients transplanted within Milan (P = .064).ConclusionLower cumulative CD4+ T-cell function post-LT predicted a higher risk of HCC recurrence. These findings may have implications toward management of HCC patients after LT.