Recipient Pre-Operative Neutrophil Lymphocyte Ratio Better Predicts Delayed Graft Function than Platelet Lymphocyte Ratio in Donation after Brain Death Kidney Transplantation

Abstract

Background: Neutrophil lymphocyte Ratio (NLR) and Platelet lymphocyte Ratio (PLR) are an indicator of the status of inflammation. The objective of this study was to evaluate the relationship between recipient pre-operative Neutrophil lymphocyte Ratio (NLR) and Platelet lymphocyte Ratio (PLR) with delayed graft function in the kidney transplant patient.
 Methods: The preoperative full blood count, data regarding patient demographics and postoperative graft function was retrospectively evaluated from the database of our institution. All statistical calculations were carried out using SPSS 20.0 version (SPSS Inc., Chicago, IL, USA). A p-value<0.05 was considered statistically significant.
 Results: 289 patients were included in this study. DGF occurred in 33 cases. Elevated preoperative NLR had a sensitivity of 75.75% and specificity of 76.56% whereas elevated preoperative PLR had a sensitivity of 72.72% and specificity of 58.20% for predicting DGF. The area under the ROC curve was found to be 0.762 and 0.655 for NLR and PLR, respectively. Multivariate analysis showed NLR>3.5 and PLR>120 independently responsible for DGF.
 Conclusion: Recipient preoperative NLR and PLR can predict the occurrence of DGF following DBD renal transplantation. In addition, NLR is better than PLR in predicting DGF. DGF prolongs the total ICU and in-hospital stay.

The Systemic Immune-Inflammation Index Predicts Clinical Outcomes in Kidney Transplant Recipients

“…To our knowledge, this is the first study to apply SII to prognostication in kidney transplantation, however, inflammatory biomarkers including NLR and PLR have previously been used in this setting. Interestingly, several institutional cohort studies examining the associations between NLR and PLR and DGF and AR remain divided in their findings (14)(15)(16)(17)(18). Among those studies reporting an association between high NLR and PLR and the development of immunological injury, the primary cited mechanism involves neutrophilia and thrombocytosis occurring during ischemia-reperfusion injury, both of which contribute to the formation of immunogenic microthrombi within the renal vasculature (3,14,15,25).…”

“…Interestingly, several institutional cohort studies examining the associations between NLR and PLR and DGF and AR remain divided in their findings (14)(15)(16)(17)(18). Among those studies reporting an association between high NLR and PLR and the development of immunological injury, the primary cited mechanism involves neutrophilia and thrombocytosis occurring during ischemia-reperfusion injury, both of which contribute to the formation of immunogenic microthrombi within the renal vasculature (3,14,15,25). Conversely, those studies reporting increased incidence of DGF and AR among patients with low NLR and PLR attributed their findings to a relative increase in circulating lymphocytes (16,17).…”

“…In the past decade, research on the transplant community has given increasing attention to the development and identification of novel biomarkers that allow for rapid, safe, non-invasive, and accurate detection of immunological injury to the kidney allograft (4, 5). Of particular interest are prognostic and predictive biomarkers that can identify patients at increased risk for allograft injury, including DGF and AR (6, 7).The neutrophil-to-lymphocyte ratio (NLR) and platelet-tolymphocyte ratio (PLR) are two biomarkers that provide an indication of inflammatory status and have been shown to be strong predictors of negative prognosis in a variety of conditions including cancer (8, 9), cardiovascular disease (10, 11), ESRD (12), and, more recently, kidney and liver transplantation (13)(14)(15)(16)(17)(18). Despite a growing body of evidence examining the utility of NLR and PLR to predict immunologic injury, the literature remains divided regarding the association between these inflammatory markers and development of DGF and AR.…”

“…Despite a growing body of evidence examining the utility of NLR and PLR to predict immunologic injury, the literature remains divided regarding the association between these inflammatory markers and development of DGF and AR. Specifically, while some studies have demonstrated an association between high NLR and PLR and development of DGF and AR (14,15,18), others report the opposite findings (16,17). This lack of consensus suggests a need for ongoing investigation to identify additional biomarkers capable of identifying patients at risk of post-transplant immunologic events.The systemic immune-inflammation index (SII) was recently introduced as a novel and powerful prognostic 3349 This article is freely accessible online.…”

“…The neutrophil-to-lymphocyte ratio (NLR) and platelet-tolymphocyte ratio (PLR) are two biomarkers that provide an indication of inflammatory status and have been shown to be strong predictors of negative prognosis in a variety of conditions including cancer (8, 9), cardiovascular disease (10, 11), ESRD (12), and, more recently, kidney and liver transplantation (13)(14)(15)(16)(17)(18). Despite a growing body of evidence examining the utility of NLR and PLR to predict immunologic injury, the literature remains divided regarding the association between these inflammatory markers and development of DGF and AR.…”