Neutrophil-to-lymphocyte ratio predicts early acute cellular rejection in living donor liver transplantation

Abstract

Purpose: The aim of this study was to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) in acute cellular rejection (ACR) after living donor liver transplantation (LDLT).

Methods: All consecutive patients who underwent ABO-compatible (ABOc) LDLT from September 2014 to December 2017 were retrospectively reviewed. NLR was calculated on 3 occasions; (1) 4 weeks prior to liver transplantation (LT), (2) the day of LT, and (3) the day before liver biopsy.

Results: Among 66 patients who underwent ABOc LDLT, ACR was identified in 15 patients (22.7%) on protocol liver biopsy performed routinely on the postoperative day 7. There was no significant difference in NLR at 4 weeks prior to LT and the day of LT between no-ACR and ACR group (2.98 ± 1.92 vs. 2.54 ± 1.15, P = 0.433; 17.9 ± 8.31 vs. 20.5 ± 13.4, P = 0.393). However, NLR was significantly lower in ACR group compared to non-ACR group just prior to liver biopsy (5.82 ± 3.42 vs. 18.4 ± 17.2, P = 0.035). NLR tends to decrease 3.5 days before the onset of ACR. The area under the receiver operating characteristic curve for optimal cut-off value of NLR was 6.49, with sensitivity and specificity of 80.4% and 73.3% respectively.

Conclusion: NLR has a potential as a noninvasive predictor of early ACR in ABOc LDLT.

Keywords: Liver transplantation; Lymphocytes; Neutrophils; Rejection.

Fig. 1. It shows the trend of the percentage of serum neutrophil, lymphocyte, eosinophil, and neutrophil-to-lymphocyte ratio (NLR) according to the postoperative course in the acute cellular rejection (ACR) group. NLR tends to decrease in the 3.5 days before the onset of ACR. LT, liver transplantation.

Fig. 2. The receiver operating characteristic (ROC) curve for the neutrophil-to-lymphocyte ratio (NLR) for predicting the occurrence of acute cellular rejection (ACR). In the ROC curve for ACR, the area under the ROC curve of NLR was 81.0%. The optimal cut-off value was 6.49, and the sensitivity and specificity of NLR were 80.4% and 73.3%, respectively.