title: Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma.
abstract: BACKGROUND
  The Milan criteria have been adopted by United Network for Organ Sharing (UNOS) to preoperatively assess outcome in patients with hepatocellular carcinoma (HCC) who receive orthotopic liver transplantation (OLT). These criteria rely solely on radiographic appearances of the tumor, providing no measure of tumor biology. Recurrence rates, therefore, remain around 20% for patients within the criteria. The neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status previously established as a prognostic indicator in colorectal liver metastases. We aimed to determine whether NLR predicts outcome in patients undergoing OLT for HCC.
  
  
  METHODS
  Analysis of patients undergoing OLT for HCC between 2001 and 2007 at our institution. A NLR > or =5 was considered to be elevated.
  
  
  RESULTS
  : A total of 150 patients were identified, with 13 patients having an elevated NLR. Of these, 62% developed recurrence compared with 14% with normal NLR (P < 0.0001). The disease-free survival for patients with high NLR was significantly worse than that for patients with normal NLR (1-, 3-, and 5-year survivals of 38%, 25%, and 25% vs. 92%, 85%, and 75%, P < 0.0001). Patients with high NLR also had poorer overall survival (5-year survival, 28% vs. 64%, P = 0.001). Patients within Milan with an elevated NLR had significantly poorer disease-free survival than those with normal NLR within Milan (5-year survival, 30% vs. 81%, P < 0.0001). On univariate analysis, 9 factors including an NLR > or =5 were significant predictors of poor disease-free survival. However, only a raised NLR remained significant on multivariate analysis (P = 0.005, HR: 19.98).
  
  
  CONCLUSIONS
  Elevated NLR significantly increases the risk for tumor recurrence and recipient death. Preoperative NLR measurement may provide a simple method of identifying patients with poorer prognosis and act as an adjunct to Milan in determining, which patients benefit most from OLT.
authors: Department of Organ Transplantation, New York Presbyterian Hospital, Columbia University, MHB-7GS-313, 177 Ft Washington Avenue, New York, NY 10032, USA. kh2369@columbia.edu
authors: Karim J
authors: KJ
authors: Halazun
authors: Mark A
authors: MA
authors: Hardy
authors: Abbas A
authors: AA
authors: Rana
authors: David C
authors: DC
authors: Woodland
authors: Elijah J
authors: EJ
authors: Luyten
authors: Suhari
authors: S
authors: Mahadev
authors: Piotr
authors: P
authors: Witkowski
authors: Abbey B
authors: AB
authors: Siegel
authors: Robert S
authors: RS
authors: Brown
authors: Jean C
authors: JC
authors: Emond
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000276:immunology* / Q000601:surgery; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000276:immunology* / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000276:immunology*; D009504:Neutrophils; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome