title: Elevated preoperative recipient neutrophil-lymphocyte ratio is associated with delayed graft function following kidney transplantation.
abstract: BACKGROUND
  The neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status. We studied the effect of preoperative elevated NLR in the recipient in relation to the risk of developing delayed graft function (DGF) after kidney transplantation.
  
  
  METHODS
  We retrospectively analysed the preoperative white blood cell count of renal transplant recipients between 2003 and 2005. An NLR >3.5 was considered elevated. There were 398 kidney transplant recipients of whom 249 received organs from donors after brain death (DBD), 61 from donors after circulatory death (DCD), and 88 from living donors.
  
  
  RESULTS
  One hundred three patients (26%) developed DGF, of which 67 (65%) had NLRs >3.5. Of 295 recipients with primary graft function, only 44 (15%) had elevated NLR. Univariate analysis revealed three factors that significantly influenced graft function: NLR >3.5, cold ischemic time (CIT) >15 hours, and donor type. On multivariate analysis, both donor type (DCD: hazard ratio [HR] = 2.421, confidence interval [CI] = 1.195-4.905, P = .014; LD: HR = 0.289, CI = 0.099-0.846, P = .024) and NLR (HR = 10.673, CI = 6.151-18.518, P < .0001) remained significant.
  
  
  CONCLUSIONS
  Elevated recipient preoperative NLR could contribute to increase the risk of developing DGF, which appears to be more pronounced in patients receiving grafts from living donors.
authors.affiliation: Abdominal Transplantation Unit, Columbia University, New York, New York, United States.
authors.forename: K J
authors.initials: KJ
authors.lastname: Halazun
authors.forename: G
authors.initials: G
authors.lastname: Marangoni
authors.forename: A
authors.initials: A
authors.lastname: Hakeem
authors.forename: S M
authors.initials: SM
authors.lastname: Fraser
authors.forename: S G
authors.initials: SG
authors.lastname: Farid
authors.forename: N
authors.initials: N
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D055815:Young Adult