Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3317-3324
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3317
High neutrophil-lymphocyte ratio indicates poor prognosis for acute-on-chronic liver failure after liver transplantation
Bing-Yi Lin, Lin Zhou, Lei Geng, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Jia Yao, Shu-Sen Zheng
Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Lin Zhou, Lei Geng, Jia Yao, Shu-Sen Zheng, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: All authors contributed equally to this paper.
Supported by National Natural Science Foundation of China for Innovative Research Group, No. 81121002; and grants from Scientific Research Project of Education Department of Zhejiang Province, No. Y201223762.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shu-Sen Zheng, PhD, MD, FACS, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, No. 866 Yuhangtang Road, Hangzhou 310003, Zhejiang Province, China. zyzss@zju.edu.cn
Telephone: +86-571-87236601 Fax: +86-571-87236628
Received: August 7, 2014
Peer-review started: August 8, 2014
First decision: September 27, 2014
Revised: October 14, 2014
Accepted: December 22, 2014
Article in press: December 22, 2014
Published online: March 21, 2015
Processing time: 223 Days and 17.6 Hours
Abstract

AIM: To investigate the significance of pre-transplant neutrophil-lymphocyte ratio (NLR) in determining the prognosis of liver transplant (LT) recipients with acute-on-chronic liver failure (ACLF).

METHODS: Data were collected from the liver transplantation data bank. The NLR values and other conventional inflammatory markers were evaluated for their ability to predict the prognosis of 153 patients with ACLF after LT. The NLR cut-off value was based on a receiver operating characteristic curve analysis. A Kaplan-Meier curve analysis and univariate and multivariate Cox regression models were used to define the independent risk factors for poor outcomes.

RESULTS: The optimal NLR cut-off value was 4.6. Out of 153 patients, 83 (54.2%) had an NLR ≥ 4.6. The 1-, 3-, and 5-year overall survival rates were 94.3%, 92.5% and 92.5%, respectively, in the normal NLR group and 74.7%, 71.8% and 69.8%, respectively, in patients with high NLRs (P < 0.001). Furthermore, there was a significant difference in infectious complications after LT between the high and normal NLR groups. There were no significant differences for other complications. In the multivariate Cox regression model, a high NLR was defined as a significant predictor of poor outcomes for LT.

CONCLUSION: A high NLR is a convenient and available predictor for prognosis of LT patients and can potentially optimize the current criteria for LT in ACLF.

Keywords: Liver transplantation; Acute-on-chronic liver failure; Neutrophil-lymphocyte ratio; Acute liver failure; Inflammation

Core tip: In China, because of a great many patients with hepatitis B, liver donation is far away from filling in the need of liver transplantation. Therefore, improving the prognosis of liver transplant (LT) is a hot issue. However, the criteria of LT for acute-on-chronic liver failure (ACLF) are according to acute liver failure, and about 20% of liver recipients are still have poor survival outcomes. The pre-transplant high neutrophil-lymphocyte ratio is a reflection of suboptimal patient conditions and immune response disorder, which could precisely predict the prognosis of LT. This result potentially was applied to select appropriate candidates for LT and even improve the current criteria of LT for ACLF.