Recovery from post-renal transplant lymphopenia predicts graft function and survival

Renal transplantation remains the gold standard for treating end-stage renal disease, yet early identification of patients at risk for graft dysfunction is essential to improving outcomes. Lymphocytes play a key role in the immune response and transplant rejection. Fluctuations in postoperative lymphocyte counts may arise from surgical stress and immunosuppression. We conducted a retrospective study of prospectively collected data with 376 consecutive adult renal transplant recipients at a single center from 2015 to 2023. Lymphopenia was observed after kidney transplantation with nadir on post-operative day (POD) 3 and gradual recovery by POD5. Multivariable analysis revealed that POD5 lymphocyte count < 0.5x10⁹ cells/L was associated with increased odds of acute rejection (OR = 2.97;p = 0.037). Rapid recovery from lymphopenia on POD3 to POD5 predicted lower odds of delayed graft function (OR = 0.38;p = 0.047), and delayed recovery from POD3 to POD4 predicted higher risk of 3-year graft failure (OR = 5.23; p = 0.025). These findings suggest that early lymphocyte trends may serve as accessible, clinically relevant biomarkers for graft prognosis following renal transplantation.