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. 2022 Dec;44(1):1897-1903.
doi: 10.1080/0886022X.2022.2141646.

Dynamic changes of neutrophil-to-lymphocyte ratio in brain-dead donors and delayed graft function in kidney transplant recipients

Yongfang Zhang  1 , Rumin Liu  2 , Xiaolin Zhao  1 , Zhiyu Ou  2 , Shengnan Wang  1 , Dongmei Wang  1 , Kaibin Huang  1 , Suyue Pan  1 , Yongming Wu  1
Affiliations

Dynamic changes of neutrophil-to-lymphocyte ratio in brain-dead donors and delayed graft function in kidney transplant recipients

Yongfang Zhang et al. Ren Fail. 2022 Dec.

Abstract

Objectives: Neutrophil-to-lymphocyte ratio (NLR) is a simple parameter implying the inflammatory status. We aimed to explore the association of brain-dead donor NLR change with delayed graft function (DGF) in kidney transplant recipients.

Methods: We retrospectively analyzed the data on 102 adult brain-dead donors and their corresponding 199 kidney transplant recipients (2018 - 2021). We calculated ΔNLR by subtracting the NLR before evaluating brain death from the preoperative NLR. Increasing donor NLR was defined as ΔNLR > 0.

Results: Forty-four (22%) recipients developed DGF after transplantation. Increasing donor NLR was significantly associated with the development of DGF in recipients (OR 2.8, 95% CI 1.2 - 6.6; p = .018), and remained significant (OR 2.6, 95% CI 1.0 - 6.4; p = .040) after adjustment of confounders including BMI, hypertension, diabetes, and the occurrence of cardiac arrest. When acute kidney injury (AKI) was included in the multivariable analysis, increasing donor NLR lost its independent correlation with DGF, while AKI remained an independent risk factor of recipient DGF (OR 4.5, 95% CI 2.7 - 7.6; p < .001). The area under the curve of combined increasing NLR and AKI in donors (0.873) for predicting DGF was superior to increasing donor NLR (0.625, p = .015) and AKI alone (0.859, p < .001).

Conclusions: Dynamic changes of donor NLR are promising in predicting post-transplant DGF. It will assist clinicians in the early recognition and management of renal graft dysfunction. Validation of this new biomarker in a large study is needed.

Keywords: Neutrophil-to-lymphocyte ratio; acute kidney injury; brain-dead donor; delayed graft function; kidney transplantation.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Flowchart of the inclusion.
Figure 2.
Figure 2.
Dynamic change of aNLR, pNLR, and ΔNLR between DGF group and non-DGF group. aNLR, tested within 24 hours before evaluating brain death; pNLR, tested within 6 h before organ procurement; ΔNLR = pNLR – aNLR. *p < .05.
Figure 3.
Figure 3.
ROC curves of increasing NLR (ΔNLR > 0), AKI and the model including increasing NLR and AKI in donors for the prediction of recipient DGF.
See this image and copyright information in PMC

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