Role of Preoperative Neutrophil-Lymphocyte Ratio in Predicting Prognosis After Liver Transplantation for Chronic Liver Failure.

Abstract

Introduction: The neutrophil-lymphocyte ratio (NLR) is an easily calculable biomarker known to have a predictive value in cardiac disease, malignancy, and renal failure. However, it has not been studied before in chronic liver disease patients undergoing liver transplantation. We aimed to evaluate the role of the pre-transplantation NLR in predicting the prognosis of patients with chronic liver failure undergoing liver transplantation.

Method: Data was retrospectively collected from 46 patients with chronic liver disease who underwent liver transplantation. The patients were divided into two groups. Group A had 23 patients who survived after liver transplantation. Group B had 23 patients who did not survive. NLR was calculated by dividing the percentage of neutrophils by the percentage of lymphocytes in peripheral blood. The NLR cut-off value was based on a receiver operating characteristic curve analysis. Postoperative complications were also noted.

Results: Preoperative NLR of 3.46 can predict post-transplantation mortality, with the area under the curve (AUC) of 0.86, having a sensitivity of 86.96% and a specificity of 73.91%. NLR emerged as an independent predictor of mortality (hazard ratio (HR) = 4.1, p = 0.028) after adjusting for the Model for End-Stage Liver Disease-Sodium (MELD-Na), creatinine, and neutrophil count. A rising NLR trend was significantly associated with the development of postoperative complications like neurological disease (p < 0.001), coagulopathy (p = 0.004), and acute kidney injury (p = 0.043).

Conclusion: A high preoperative NLR is a predictor of poor outcomes in liver transplantation patients with chronic liver disease.