Abstract
Liver transplantation (LT) is closely associated with decreased immune function, a contributor to herpes zoster (HZ). However, risk factors for HZ in living donor LT (LDLT) remain unknown. Neutrophil-lymphocyte ratio (NLR) and immune system function are reportedly correlated. This study investigated the association between NLR and HZ in 1688 patients who underwent LDLT between January 2010 and July 2020 and evaluated risk factors for HZ and postherpetic neuralgia (PHN). The predictive power of NLR was assessed through the concordance index and an integrated discrimination improvement (IDI) analysis. Of the total cohort, 138 (8.2%) had HZ. The incidence of HZ after LT was 11.2 per 1000 person-years and 0.1%, 1.3%, 2.9%, and 13.5% at 1, 3, 5, and 10 years, respectively. In the Cox regression analysis, preoperative NLR was significantly associated with HZ (adjusted hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02–1.09; p = 0.005) and PHN (HR, 1.08; 95% CI, 1.03–1.13; p = 0.001). Age, sex, mycophenolate mofetil use, and hepatitis B virus infection were risk factors for HZ versus age and sex for PHN. In the IDI analysis, NLR was discriminative for HZ and PHN (p = 0.020 and p = 0.047, respectively). Preoperative NLR might predict HZ and PHN in LDLT recipients.
Highlights
Herpes zoster (HZ) is a viral disease caused by varicella zoster virus (VZV) reactivation and has an estimated incidence of 1.2–4.8 per 1000 individuals in the general population [1]
The addition of preoperative neutrophil-lymphocyte ratio (NLR) to the clinical model for predicting HZ consisting of age, mycophenolate mofetil (MMF), sex, and hepatitis B virus (HBV) infection showed no significant improvement in concordance index (C-index) (p = 0.712) but showed significant discriminative power in the integrated discrimination improvement (IDI) analysis (HR, 0.008; 95% CI, 0.001–0.029; p = 0.020) (Table 4)
Our study demonstrated that the preoperative NLR was strongly associated with the incidence of HZ and postherpetic neuralgia (PHN) in living donor LT (LDLT)
Summary
Herpes zoster (HZ) is a viral disease caused by varicella zoster virus (VZV) reactivation and has an estimated incidence of 1.2–4.8 per 1000 individuals in the general population [1]. Previous studies reported that solid-organ transplant (SOT) recipients have a 2- to 10-fold higher risk of VZV reactivation than the general population [9,10,11]. Pergam and colleagues reported that LT patients generally require less immunosuppression because the liver is relatively resistant to rejection compared to other organs and that the incidence of HZ is slightly lower than that of lung and heart transplant patients [11]. NLR is a simple and objective biomarker of patient survival and surblood and reflects a patient’s inflammatory condition (neutrophil count) and adaptive gical prognosis in various diseases, such as major cardiac disease and several cancers immunity (lymphocyte count). We assessed the association between preoperative NLR and postherpetic neuralgia (PHN).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
