Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Abstract

Background & Aims:Early allograft dysfunction (EAD) is predictive of poor graft and patient survival following living donor liver transplantation (LDLT). Considering the impact of the inflammatory response on graft injury extent following LDLT, we investigated the association between neutrophil-to-lymphocyte ratio (NLR) and EAD, 1year graft failure, and mortality following LDLT, and compared it to C-reactive protein (CRP), procalcitonin, platelet-to-lymphocyte ratio and the Glasgow prognostic score. Methods:A total of 1960 consecutive adult LDLT recipients (1531/429 as development/validation cohort) were retrospectively evaluated. Cut-offs were derived using the area under the receiver operating characteristic curve (AUROC), and multivariable regression and Cox proportional hazard analyses were performed.Results: The risk of EAD increased proportionally with increasing NLR, and the NLR AUROC was 0.73, similar to CRP and procalcitonin and higher than the rest. NLR ≥ 2.85 (best cut-off) showed a significantly higher EAD occurrence (20.5% vs 5.8%, P < 0.001), higher 1-year graft failure (8.2% vs 4.9%, log-rank P = 0.009) and higher 1-year mortality (7% vs 4.5%, log-rank P = 0.039). NLR ≥ 2.85 was an independent predictor of EAD (odds ratio, 1.89 [1.26-2.84], P = 0.002) after multivariable adjustment, whereas CRP and procalcitonin were not. Increasing NLR was independently associated with higher 1-year graft failure and mortality (both P < 0.001).Consistent results in the validation cohort strengthened the prognostic value of NLR. Conclusions:Preoperative NLR ≥ 2.85 predicted higher risk of EAD, 1-year graft failure and 1-year mortality following LDLT, and NLR was superior to other parameters, suggesting that preoperative NLR may be a practical index for predicting graft function following LDLT. K E Y W O R D S early allograft dysfunction, inflammatory status, living donor liver transplantation, neutrophilto-lymphocyte ratio S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Kwon H-M, Moon Y-J, Jung K-W, et al.Neutrophil-to-lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation. Liver

The Post-Transplant Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Relation to Graft Function among Renal Transplant Recipients

“…Ergin et al (16) reported that NLR values >2.5 were associated with AR (median NLR 4.06 vs. 1.24) in kidney transplant patients. In a study investigating early allograft rejection and NLR rate in 1531 liver transplant patients, the NLR rate was found to be significantly higher in patients with rejection (median 3.49 vs. 2.07) and NLR ≥2,85 (OR=1.89) was an independent predictor of early allograft rejection (21). Similar results were obtained in our study (median NLR 3.75 vs 1.99).…”

Neutrophils in liver diseases: pathogenesis and therapeutic targets

“…Liver transplantation provides a life-saving alternative, and the NLR can be used as a practical index of early graft dysfunction for living donor liver transplantation. 56 Paracetamol abuse is the most commonly observed reason for acute liver failure in developed countries. In APAP-induced liver failure, depletion of neutrophils protects against APAP toxicity when given as a 24-h pretreatment.…”

Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study

“…In patients with ESLD who are scheduled for liver transplantation (LT), many factors may influence the occurrence of early allograft dysfunction (EAD) after LT, such as kidney disease, renal replacement therapy, the Model for End-Stage Liver Disease (MELD) score, and donor characteristics [4–7]. Severe systemic inflammation before surgery has been shown to be related to patients’ increased risk of EAD development in the LDLT setting [8,9]. A previous LDLT study demonstrated significant associations of the neutrophil-to-lymphocyte ratio (NLR) with EAD, 1-year graft failure, and mortality following surgery [8].…”

“…Severe systemic inflammation before surgery has been shown to be related to patients’ increased risk of EAD development in the LDLT setting [8,9]. A previous LDLT study demonstrated significant associations of the neutrophil-to-lymphocyte ratio (NLR) with EAD, 1-year graft failure, and mortality following surgery [8]. As the occurrence of EAD seems to be related to severe inflammatory activity derived from ischemia–reperfusion injury [10,11], the preoperative immune condition in patients undergoing LDLT may be a useful predictor of the degree of ischemia–reperfusion injury, as supported by the relationship between the preoperative levels of proinflammatory biomarkers (i.e., interleukin [IL]-2, -6, and -17) and the occurrence of EAD [9,12].…”