Main Article Content
Objective: Liver transplantation has been reported to be a predictor of patient survival in acute coronary syndrome and various malignancies, including hepatocellular carcinoma (HCC). In a previous study, it was demonstrated that high Platelet-to-Lymphocyte Ratio (PLR) values before treatment are an independent prognostic factor predicting poor survival in patients with large HCC. We aimed to investigate whether preoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and thrombocyte count are prognostic factors for posttransplantation mortality or graft function in patients who underwent liver transplantation in the clinic.
Material and Methods: The data of 40 patients who underwent liver transplantation in the clinic during January 2018–December 2020 were retrospectively analyzed and included in the study.
Results: The mean age of the 40 patients included in the study was 51.1 ± 11.7 years. Of these, 27 (67.5%) were male, and 13 (32.5%) were female. Living-donor liver transplantation was performed in 33 patients, whereas cadaveric liver transplantation was performed in seven patients. The mean ejection fraction (EF) was 56.7% ± 3.2%, and the mean model for end-stage liver disease score was 22.4 ± 5.4. After one year of follow-up, 10 out of 40 patients (25%) died after orthotopic liver transplantation. The mean preoperative neutrophil count was found to be 5.7 ± 2.4 × 109/l in non-surviving patients and 3.1 ± 2.05 × 109/l in surviving patients. It was found that mortality increased in patients with high preoperative neutrophil values (NLR > 3.7, p < 0.001) and preoperative platelet count (<79.52 × 109/L, p < 0.001).
Conclusion: Preoperative neutrophilia, thrombocytopenia and high NLR values may predict poor prognosis in patients undergoing OLT.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
2. Udompap P, Kim D, Kim WR. Current and future burden of chronic nonmalignant liver disease. Clinical Gastroenterology and Hepatology. 2015;13(12):2031-41.
3. Turkey Organ Transplant Foundation. 2020. Available from: https://www.tonv.org.tr/karaciger-nakli/.
4. Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L. Survival after liver transplantation in the United States: a disease‐specific analysis of the UNOS database. Liver transplantation. 2004;10(7):886-97.
5. Bhutta H, Agha R, Wong J, Tang TY, Wilson YG, Walsh SR. Neutrophil-lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross-sectional study. Vascular and endovascular surgery. 2011;45(3):227-31.
6. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. The American journal of cardiology. 2006;97(7):993-6.
7. Celikbilek M, Dogan S, Ozbakır O, Zararsız G, Kücük H, Gürsoy S, et al. Neutrophil–lymphocyte ratio as a predictor of disease severity in ulcerative colitis. Journal of clinical laboratory analysis. 2013;27(1):72-6.
8. Huang H, Wan X, Bai Y, Bian J, Xiong J, Xu Y, et al. Preoperative neutrophil–lymphocyte and platelet–lymphocyte ratios as independent predictors of T stages in hilar cholangiocarcinoma. Cancer management and research. 2019;11:5157.
9. Walsh S, Cook E, Goulder F, Justin T, Keeling N. Neutrophil‐lymphocyte ratio as a prognostic factor in colorectal cancer. Journal of surgical oncology. 2005;91(3):181-4.
10. Gomez D, Farid S, Malik H, Young A, Toogood G, Lodge J, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World journal of surgery. 2008;32(8):1757-62.
11. Lin B-Y, Zhou L, Geng L, Zheng Z-Y, Jia J-J, Zhang J, et al. High neutrophil-lymphocyte ratio indicates poor prognosis for acute-on-chronic liver failure after liver transplantation. World Journal of Gastroenterology: WJG. 2015;21(11):3317.
12. Lesurtel M, Raptis DA, Melloul E, Schlegel A, Oberkofler C, El‐Badry AM, et al. Low platelet counts after liver transplantation predict early posttransplant survival: the 60‐5 criterion. Liver Transplantation. 2014;20(2):147-55.
13. Li L, Wang H, Yang J, Jiang L, Yang J, Wang W, et al. Immediate postoperative low platelet counts after living donor liver transplantation predict early allograft dysfunction. Medicine. 2015;94(34).
14. Templeton AJ, Ace O, McNamara MG, Al-Mubarak M, Vera-Badillo FE, Hermanns T, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiology and Prevention Biomarkers. 2014;23(7):1204-12.
15. Wang Y, Attar BM, Fuentes HE, Jaiswal P, Tafur AJ. Evaluation of the prognostic value of platelet to lymphocyte ratio in patients with hepatocellular carcinoma. Journal of gastrointestinal oncology. 2017;8(6):1065.
16. Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. Journal of gynecologic oncology. 2012;23(4):265.
17. Krenn-Pilko S, Langsenlehner U, Thurner E, Stojakovic T, Pichler M, Gerger A, et al. The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients. British journal of cancer. 2014;110(10):2524-30.
18. Liu H, Wu Y, Wang Z, Yao Y, Chen F, Zhang H, et al. Pretreatment platelet-to-lymphocyte ratio (PLR) as a predictor of response to first-line platinum-based chemotherapy and prognosis for patients with non-small cell lung cancer. Journal of thoracic disease. 2013;5(6):783.
19. Mendes-Braz M, Elias-Miró M, Jiménez-Castro M, Casillas-Ramírez A, Ramalho F, Peralta C. The current state of knowledge of hepatic ischemia-reperfusion injury based on its study in experimental models. Journal of Biomedicine and Biotechnology. 2012;2012.
20. Papadopoulos D, Siempis T, Theodorakou E, Tsoulfas G. Hepatic ischemia and reperfusion injury and trauma: current concepts. Archives of Trauma Research. 2013;2(2):63.
21. Honda M, Takeichi T, Asonuma K, Tanaka K, Kusunoki M, Inomata Y. Intravital imaging of neutrophil recruitment in hepatic ischemia-reperfusion injury in mice. Transplantation. 2013;95(4):551-8.
22. Vedder NB, Fouty BW, Winn RK, Harlan JM, Rice CL. Role of neutrophils in generalized reperfusion injury associated with resuscitation from shock. Surgery. 1989;106(3):509-16.
23. Tsujii S, Okabayashi T, Shiga M, Takezaki Y, Sugimoto T, Kobayashi M, et al. The effect of the neutrophil elastase inhibitor sivelestat on early injury after liver resection. World journal of surgery. 2012;36(5):1122-7.
24. Uchida Y, Freitas MCS, Zhao D, Busuttil RW, Kupiec-Weglinski JW. The protective function of neutrophil elastase inhibitor in liver ischemia and reperfusion injury. Transplantation. 2010;89(9):1050.
25. Xue F, Wang G, Pang Z, Liu C, Liang T. Protective Effect of Glutathione Against Liver Warm Ischemia‐Reperfusion Injury in Rats is Associated with Regulation of P‐Selectin and Neutrophil Infiltration. The Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology: Advances in Integrative Anatomy and Evolutionary Biology. 2008;291(8):1016-22.
26. Heffernan DS, Monaghan SF, Thakkar RK, Machan JT, Cioffi WG, Ayala A. Failure to normalize lymphopenia following trauma is associated with increased mortality, independent of the leukocytosis pattern. Critical Care. 2012;16(1):1-10.
27. Ray-Coquard I, Cropet C, Van Glabbeke M, Sebban C, Le Cesne A, Judson I, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer research. 2009;69(13):5383-91.
28. Fernández‐Ruiz M, López‐Medrano F, Romo EM, Allende LM, Meneu JC, Fundora‐Suárez Y, et al. Pretransplant lymphocyte count predicts the incidence of infection during the first two years after liver transplantation. Liver transplantation. 2009;15(10):1209-16.
29. Atlas A, Duran E, Pehlivan B, Pehlivan VF, Erol MK, Altay N. The Effect of Increased Neutrophil Lymphocyte Ratio on Mortality in Patients Operated on Due to Hip Fracture. Cureus. 2020;12(1).
30. Russell CD, Parajuli A, Gale HJ, Bulteel NS, Schuetz P, de Jager CP, et al. The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: a systematic review and meta-analysis. Journal of Infection. 2019;78(5):339-48.
31. Huguet E, Maccallini G, Pardini P, Hidalgo M, Obregon S, Botto F, et al. Reference Values for Neutrophil to Lymphocyte Ratio (NLR), a Biomarker of Cardiovascular Risk, According to Age and Sex in a Latin American Population. Current problems in cardiology. 2019:100422.
32. Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: a systematic review and meta-analysis of 66 cohort studies. Cancer treatment reviews. 2017;58:1-13.
33. Forget P, Khalifa C, Defour J-P, Latinne D, Van Pel M-C, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC research notes. 2017;10(1):1-4.
34. Harimoto N, Shirabe K, Nakagawara H, Toshima T, Yamashita Y-i, Ikegami T, et al. Prognostic factors affecting survival at recurrence of hepatocellular carcinoma after living-donor liver transplantation: with special reference to neutrophil/lymphocyte ratio. Transplantation. 2013;96(11):1008-12.
35. Chatzipetrou MA, Tsaroucha AK, Weppler D, Pappas PA, Kenyon NS, Nery JR, et al. Thrombocytopenia after liver transplantation. Transplantation. 1999;67(5):702-6.
36. Nobuoka Y, Wada H, Mizuno S, Kishiwada M, Usui M, Sakurai H, et al. Prolonged thrombocytopenia after living donor liver transplantation is a strong prognostic predictor irrespective of history of splenectomy: the significance of ADAMTS13 and graft function. International journal of hematology. 2014;99(4):418-28.
37. Han S, Lee S, Yang JD, Leise MD, Ahn JH, Kim S, et al. Risk of posttransplant hepatocellular carcinoma recurrence is greater in recipients with higher platelet counts in living donor liver transplantation. Liver Transplantation. 2018;24(1):44-55.
38. Kwon H-C, Kim SH, Oh SY, Lee S, Lee JH, Choi H-J, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012;17(3):216-22.
39. Dan W, Ming W, Feng F-z, Huang H-f, Yang J-x, Keng S, et al. Pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios do not predict survival in patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy. Chinese medical journal. 2013;126(8):1464-8.
40. Xue T-C, Jia Q-A, Ge N-L, Zhang B-H, Wang Y-H, Ren Z-G, et al. The platelet-to-lymphocyte ratio predicts poor survival in patients with huge hepatocellular carcinoma that received transarterial chemoembolization. Tumor Biology. 2015;36(8):6045-51.
41. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91-6.
42. Panchal HJ, Durinka JB, Patterson J, Karipineni F, Ashburn S, Siskind E, et al. Survival outcomes in liver transplant recipients with Model for End‐stage Liver Disease scores of 40 or higher: a decade‐long experience. HPB. 2015;17(12):1074-84.
43. Olthoff KM, Merion RM, Ghobrial RM, Abecassis MM, Fair JH, Fisher RA, et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Annals of surgery. 2005;242(3):314.
44. Yaprak O, Dayangac M, Balcı D, Duran C, Uraz S, Ayanoğlu Ö, et al. Karaciğer nakli sonuçları üzerinde kan transfüzyonlarının etkisi ve transfüzyon gereksinimini etkileyen faktörler. 2008.