Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3317
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
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.
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.