High Neutrophil-to-Lymphocyte Ratio Predicts Outcomes in Patients with Primary Sclerosing Cholangitis Undergoing Liver Transplantation

Abstract

Introduction: The neutrophil to lymphocyte ratio (NLR) is an indicator of systemic inflammatory response and has the potential for use as blood-based biomarker to predict outcomes in patients (pts) with many conditions. The role of NLR in predicting outcomes in patients undergoing LT for PSC is unknown. We aim to evaluate whether pre-LT NLR could be early indicators of cancer development, graft failure, PSC recurrence, and overall survival in patients with PSC undergoing liver transplantation for PSC.Figure 1Methods: We identified all pts who underwent LT for advanced stage PSC for non-cholangiocarcinoma indications at Mayo Clinic, Rochester from 1984-2012, with follow-up through December, 2015. Survival analysis was used to evaluate the predictive value of pre-LT NLR. Univariate and multivariate logistic regression was used to determine whether patients with elevated NLR were more likely to suffer postoperative complications. Results: Three hundred seventy-three pts underwent LT for PSC, of which 80 were performed for cholangiocarcinoma. Two hundred ninety-three pts who underwent LT for advanced stage PSC (mean age, 47±12 yrs; 63.1% males, 2.4% smoking at time of LT) formed our study cohort. Over a median (interquartile range) follow-up of 11.6yrs (6.5-18.6), one-hundred and eight (37.1%) of the patients died, 94(32%) developed recurrent PSC, 56 (22.2%) of the grafts failed, and 64 (21.8%) developed solid vs. hematological tumors. On multivariate analysis, a pre-LT NLR greater or equal to 4.27 (hazard ratio [HR], 2.1; 95% CI, 1.04-4.61, P=0.04) and recipient age (hazard ratio [HR], 1.05; 95% CI, 1.02-1.09, P=0.002) were associated with cancer development post-LT. Mean time to develop cancer in PSC patients with high NLR was reduced compared to PSC patients without high NLR (12.4 vs. 17.5 years, p=0.02) (figure). High pre-LT NLR was not significantly associated with graft failure, PSC recurrence, or overall survival. Conclusion: High Pre-LT NLR may be a potential risk factor for cancer development after LT for PSC.