The Post-Transplant Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Relation to Graft Function among Renal Transplant Recipients

Abstract

Aim: The aim of this study was to evaluate the association of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with acute rejection after kidney transplantation. Material and Methods: A total of 36 adult renal transplant recipients (33 males, 3 females) with a median age of 41 (range, 19-64) years were included in this retrospective study conducted between January 2016 and January 2019. Data on patient demographics and laboratory findings (neutrophil, lymphocyte, platelet, creatinine, eGFR, serum uric acid and C-reactive protein) were recorded. Acute rejection was defined via renal biopsy in accordance with Banff criteria. Results: Acute rejection occurred in 16 (44.4%) patients. NLR (median 3.75 vs. 1.99, p=0.001) and PLR (median 125.59 vs. 99.23, p=0.008) values were significantly higher in the acute rejection group than in the control group. Area under the curve was calculated to be 0.822 for NLR and to be 0.759 for PLR. Cut-off values were determined to be >2.5 (75% sensitivity and 75% specificity) for NLR and to be >108 (81% sensitivity and 65% specificity) for PLR. Univariate analysis revealed a strong correlation of acute rejection both with NLR >2.5 (Odds Ratio (OR)=0.267, 95% Confidence Interval (CI)=0.089-0.803, p=0.019) and PLR >108 (OR=0.231, 95% CI=0.066-0.810, p=0.022). Conclusion: In kidney transplant patients, there is a strong relationship between high NLR and PLR values and the development of acute rejection. As simple, easy-to-access, inexpensive and non-invasive methods, PLR, and particularly NLR, may be potential tests to diagnose post-transplant acute rejection.

Keywords

• Kidney transplantation
• neutrophil-to-lymphocyte ratio
• platelet-to-lymphocyte ratio
• acute rejection

Renal Transplant Alıcılarında Transplant Sonrası Nötrofil-Lenfosit Oranı ve Trombosit-Lenfosit Oranı ile Graft Fonksiyonu Arasındaki İlişki

Öz

Amaç: Bu çalışmanın amacı nötrofil-lenfosit oranı (NLO) ve trombosit-lenfosit oranı (TLO) ile böbrek nakli sonrası akut rejeksiyon arasındaki ilişkiyi değerlendirmektir. Gereç ve Yöntemler: Ocak 2016 ile Ocak 2019 tarihleri arasında yürütülen bu geriye dönük çalışmaya ortanca yaşı 41 (aralık, 19-64) yıl olan toplam 36 yetişkin (33 erkek, 3 kadın) böbrek nakli alıcısı dahil edildi. Hastaların demografik özellikleri ve laboratuvar bulguları (nötrofil, lenfosit, trombosit, kreatinin, eGFR, serum ürik asit, C-reaktif protein) kaydedildi. Akut rejeksiyon Banff kriterlerine göre renal biyopsi ile tanımlandı. Bulgular: On altı (%44,4) hastada akut rejeksiyon gelişti. NLO (ortanca 3,75’e karşı 1,99; p=0,001) ve TLO (ortanca 125,59’a karşı 99,23; p=0,008) değerleri akut rejeksiyon grubunda kontrol grubuna göre anlamlı olarak daha yüksekti. Eğri altındaki alan, NLO için 0,822 ve TLO için 0,759 olarak hesaplandı. Cut-off değer NLO için >2,5 (%75 duyarlılık ve %75 özgüllük) ve TLO için >108 (%81 duyarlılık ve %65 özgüllük) olarak belirlendi. Tek değişkenli analiz, NLO >2,5 (Odds Ratio (OR)=0,267; %95 Güven Aralığı (GA)=0,089-0,803; p=0,019) ve TLO >108 (OR=0,231; %95 GA=0,066-0,810; p=0,022) ile akut rejeksiyon arasında güçlü bir korelasyon olduğunu ortaya koydu. Sonuç: Böbrek nakli hastalarında, yüksek NLO ve TLO değerleri ile akut rejeksiyon gelişimi arasında güçlü bir ilişki vardır. Basit, erişimi kolay, ucuz ve invaziv olmayan yöntemler olarak TLO ve özellikle NLO, transplant sonrası akut rejeksiyonu teşhis etmek için potansiyel testler olabilirler.

Anahtar Kelimeler

• Böbrek nakli
• nötrofil-lenfosit oranı
• trombosit-lenfosit oranı
• akut rejeksiyon

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