Retrospective evaluation of neutrophil-lymphocyte ratio before and after transplantation in renal transplant patients

Objective: One of the preferred treatments for end-stage renal disease is kidney transplantation. With the use of immunosuppressives after transplantation, patients are followed closely for infection, malignancy, diabetes, coronary artery disease and systemic inflammation. Certain parameters are examined to determine systemic inflammation in many diseases, and studies on neutrophy-lymphocyte and platelet-lymphocyte ratios are increasing. In our study, it was aimed to examine neutrophil-lymphocyte, platelet-lymphocyte ratios before and after transplantation of patients who were followed up in our center for kidney transplantation, and to contribute to the literature data by increasing awareness in terms of the course of inflammation. Materials and Methods: The list of patients who were followed up for kidney transplantation between 2009 and 2020 at Karadeniz Technical University Faculty of Medicine Farabi Hospital was obtained from files and computer records. Demographic information, laboratory parameters and comorbid diseases of the patients were evaluated. While patients who can access their data to be analyzed retrospectively are included in the study; Patients with uncontrolled diabetes mellitus, hematological or solid organ cancer, active infection, inflammatory disease, and steroid use prior to kidney transplantation were not included. A total of 182 patients, 111 male and 71 female, were included in the study. Findings: The most common cause of end-stage renal disease was hypertension (34%). It was found that neutrophil-lymphocyte ratio did not change according to gender. In the last polyclinic controls after transplantation, 47% of our patients increased, 42% were hypertensive and 11% were in the normotensive range, but no significant difference was observed between neutrophil-lymphocyte ratios (p: 0.792). According to the last neutrophil-lymphocyte ratio examined before transplantation, the mean of preemptive transplants was 2.9 ± 1, and those with dialysis history were 3.1 ± 2.6 (p: 0.627). When the neutrophil-lymphocyte ratios at 12 months after transplantation with dialysis duration were examined, the mean of those 5.6 years and above was 2.8 ± 1.5, and those with a history of dialysis below 5.6 years were calculated as 2.6 ± 2 (p: 0.291). According to Human Leukocyte Antigen, there was the most common 2/6 congruent group with 33.8%. The mean neutrophil-lymphocyte in the first month was 4.7 ± 3.3 in the group with tissue compatibility <3/6, while it was 4.2 ± 2.6 in the group with 3/6 or more concordance. The 1st month neutrophil-lymphocyte mean of the group with high tissue compatibility was lower (p: 0.649). There was no relationship between the age of transplantation and the neutrophil-lymphocyte course from the 1st to the 12th month. Considering the fractional urea clearance (Kt / V) and the neutrophil-lymphocyte relationship at the 12th month, the mean of the group with ≥1.3 Kt / V was 2 ± 1.1, compared to the group with Kt / V <1.3 (3.6 ± 1, 6) lower (p: 0.029). The mean neutrophil-lymphocyte in the 1st month of the group receiving Basiliximab as induction regimen was calculated as 3.3 ± 2.7, and it was lower than the group receiving anti-thymocyte globulin (5.1 ± 3.1) (p: 0.003). It was observed that our patients mostly used Tacrolimus + Mycophenolate Mofetil + Prednisolone as an immunosuppressive regimen with 38.7%. When the neutrophil-lymphocyte progress was examined from the 1st to the 12th month after the transplantation, it was observed that the inflammatory indicators of the group receiving Mycophenolate Sodium improved more (p: 0.035). When the neutrophil-lymphocyte ratio was examined before and after transplantation in the 1st month-6th month-12th month-5th year, it was observed that it decreased continuously in the follow-up after peaking in the 1st month (p <0.001). Similarly, it was observed that the platelet-lymphocyte ratio peaked in the 6th month and continued to decrease in follow-up (p <0.001). Results: As a result of our study, it has been shown that neutrophil-lymphocyte ratio and platelet-lymphocyte ratio increase especially in the first months and return to normal level in the chronic period and can be used as an indicator of inflammation after renal transplantation.