Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Sci Rep. 2021 Feb 18;11(1):4199. doi: 10.1038/s41598-021-83814-9.
Preoperative neutrophil-lymphocyte ratio (NLR), has shown a predictive value in living donor liver transplantation (LDLT). However, the change in the NLR during LDLT has not been fully investigated. We aimed to compare graft survival between the NLR increase and decrease during LDLT. From June 1997 to April 2019, we identified 1292 adult LDLT recipients with intraoperative NLR change. The recipients were divided according to NLR change: 103 (8.0%) in the decrease group and 1189 (92.0%) in the increase group. The primary outcome was graft failure in the first year. In addition, variables associated with NLR change during LDLT were evaluated. During 1-year follow-up, graft failure was significantly higher in the decrease group (22.3% vs. 9.1%; hazard ratio 1.87; 95% confidence interval 1.10-3.18; p = 0.02), but postoperative complications did not differ between two groups. This finding was consistent for the overall follow-up. Variables associated with NLR decrease included preoperative NLR > 4, model for end-stage liver disease score, intraoperative inotropic infusion and red blood cell transfusion, and operative duration. The least absolute shrinkage and selection operator model yielded similar results. NLR decrease during LDLT appeared to be independently associated with graft survival. Further studies are needed to confirm our findings.
术前中性粒细胞与淋巴细胞比值（NLR）已被证明在活体肝移植（LDLT）中有预测价值。然而，LDLT 过程中 NLR 的变化尚未得到充分研究。我们旨在比较 LDLT 过程中 NLR 升高和降低的供体肝存活率。从 1997 年 6 月至 2019 年 4 月，我们共确定了 1292 例接受术中 NLR 变化的成人 LDLT 受者。根据 NLR 变化将受者分为两组：下降组 103 例（8.0%），升高组 1189 例（92.0%）。主要结局是移植后 1 年内的移植物失败。此外，还评估了与 LDLT 期间 NLR 变化相关的变量。在 1 年的随访期间，下降组的移植物失功发生率明显更高（22.3%比 9.1%；风险比 1.87；95%置信区间 1.10-3.18；p=0.02），但两组术后并发症无差异。在总体随访中也发现了同样的结果。与 NLR 降低相关的变量包括术前 NLR>4、终末期肝病模型评分、术中使用正性肌力药物和输血以及手术时间。最小绝对收缩和选择算子模型也得出了类似的结果。LDLT 过程中 NLR 的降低似乎与移植物存活率独立相关。需要进一步的研究来证实我们的发现。
