Association between neutrophil\u2013lymphocyte ratio change during living donor liver transplantation and graft survival

Jungchan Park,Mi Sook Gwak,Seung-Hwa Lee,Justin Sangwook Ko,Gyu-Seong Choi,Jongman Kim,Gaab Soo Kim,Sangbin Han,Jae Won Joh

doi:10.1038/s41598-021-83814-9

Jungchan Park, Mi Sook Gwak + Show 7 more

Open Access

https://doi.org/10.1038/s41598-021-83814-9

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Journal: Scientific Reports	Publication Date: Feb 18, 2021
Citations: 5	License type: open-access

Affiliation: Sungkyunkwan University, Samsung Medical Center

Abstract

Preoperative neutrophil–lymphocyte ratio (NLR), has shown a predictive value in living donor liver transplantation (LDLT). However, the change in the NLR during LDLT has not been fully investigated. We aimed to compare graft survival between the NLR increase and decrease during LDLT. From June 1997 to April 2019, we identified 1292 adult LDLT recipients with intraoperative NLR change. The recipients were divided according to NLR change: 103 (8.0%) in the decrease group and 1189 (92.0%) in the increase group. The primary outcome was graft failure in the first year. In addition, variables associated with NLR change during LDLT were evaluated. During 1-year follow-up, graft failure was significantly higher in the decrease group (22.3% vs. 9.1%; hazard ratio 1.87; 95% confidence interval 1.10–3.18; p = 0.02), but postoperative complications did not differ between two groups. This finding was consistent for the overall follow-up. Variables associated with NLR decrease included preoperative NLR > 4, model for end-stage liver disease score, intraoperative inotropic infusion and red blood cell transfusion, and operative duration. The least absolute shrinkage and selection operator model yielded similar results. NLR decrease during LDLT appeared to be independently associated with graft survival. Further studies are needed to confirm our findings.

Highlights

Preoperative neutrophil–lymphocyte ratio (NLR), has shown a predictive value in living donor liver transplantation (LDLT)
Smooth plots for the change of odds ratio (OR) was construced and showed a significant association when the reference value was an absolute NLR change of 0 (Fig. 1), so we divided the recipients into two groups according to an absolute decrease or increase of NLR change during LDLT: 103 (8.0%) recipients in the decrease group and 1189 (92.0%) in the increase group
The use of inotropic infusion was less frequent in the decrease group, and packed red blood cell transfusion was more frequent in the decrease group

Summary

Introduction

Preoperative neutrophil–lymphocyte ratio (NLR), has shown a predictive value in living donor liver transplantation (LDLT). During 1-year follow-up, graft failure was significantly higher in the decrease group (22.3% vs 9.1%; hazard ratio 1.87; 95% confidence interval 1.10–3.18; p = 0.02), but postoperative complications did not differ between two groups This finding was consistent for the overall follow-up. The NLR has been shown to have a predictive value in various clinical situations including cardiovascular disease, cancer, and liver c irrhosis[2,3,4] These findings were consistently reported in surgical patients, and a perioperative high NLR was associated with adverse events after cardiac surgery and recurrence after cancer resection[5,6,7,8,9,10]. The current clinical value of NLR in LDLT seems to be limited to using preoperative value to predict outcome

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