Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2025; 15(2): 100157
Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.100157
Significance of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio as prognostic predictors after liver transplantation
Marco Maria Pascale, Francesco Frongillo, Pierangelo Vasta, Giuseppe Massimiani, Erida Nure, Salvatore Agnes
Marco Maria Pascale, Francesco Frongillo, Erida Nure, Salvatore Agnes, General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Pierangelo Vasta, Giuseppe Massimiani, Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
Author contributions: Pascale MM, Vasta P, and Massimiani G generated conceptualization; Pascale MM contributed to methodology, data curation, and funding acquisition, and wrote the original draft; Massimiani G prepared software; Nure E performed validation and investigation; Frongillo F performed formal analysis and visualization; Vasta P and Massimiani G contributed to resources; Agnes S supervised reviewed and edited the draft; and all authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and the principles of the Good Clinical Practice guidelines. The study was approved by Fondazione Policlinico Universitario Agostino Gemelli IRCCS Ethics Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used to support the findings of this study are included in the article. The raw data are available for consultation.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Maria Pascale, MD, General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 8 largo A Gemelli, Rome 00168, Italy. marcomaria.pascale@policlinicogemelli.it
Received: August 8, 2024
Revised: December 20, 2024
Accepted: January 21, 2025
Published online: June 18, 2025
Processing time: 196 Days and 22.1 Hours
Abstract
BACKGROUND

The use of biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR) and the neutrophil-to-platelet ratio (NPR), has shown promise in evaluating early outcomes after medical, interventional, and surgical treatments. NLR has emerged as an indicator of systemic inflammation and physiological stress. NPR has emerged as a potential indicator of inflammation and thrombotic risk in the context of surgical and radiological procedures.

AIM

To analyze the correlation of NLR and NPR with the development of post-liver transplantation (LT) early complications after stratification for hepatocellular carcinoma diagnosis.

METHODS

Consecutive patients undergone LT between January 2019 and December 2023 were enrolled. Data regarding the concentration of hemoglobin and the differential leukocyte count on postoperative days (POD) 0, 1, 3, and 5 were collected.

RESULTS

The dataset included 161 consecutive patients undergone LT. Clavien-Dindo IV-V complications had a good correlation with NLR POD 1 (P = 0.05), NLR POD 3 (P < 0.001), NLR POD 7 (P < 0.001), NPR POD 3 (P < 0.001). In addition, the NPR ratio on POD 3 correlated with the onset of 30-day hemorrhage (P = 0.009). Finally, 30-day mortality had a significant association with the NLR POD 1 (P = 0.03) and with NLR POD 7 (P = 0.004), while NPR had a significant correlation with 30-day mortality in NPR POD 7 (P = 0.004).

CONCLUSION

The analysis of NLR and NPR are strictly correlated with Clavien-Dindo IV-V complications and 30-day post-LT death.

Keywords: Liver transplantation; Immunobiomarkers; Neutrophil-to-lymphocyte ratio; Neutrophil-to-platelet ratio; Post-operative complications

Core Tip: The neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-platelet ratio (NPR) are emerging biomarkers used to predict early outcomes following liver transplantation. Elevated NLR indicates systemic inflammation, which can signal complications like infection or rejection. High NPR values can reflect underlying inflammation and potential vascular complications. Both ratios are calculated from routine blood tests, making them cost-effective and readily available. Studies suggest that higher pre-transplant NLR and NPR levels are associated with increased risk of poor graft function, longer hospital stays, and mortality. Monitoring these ratios helps in identifying at-risk patients, guiding post-operative care, and improving overall transplant success.