title: Neutrophil-Lymphocyte Ratio Is Significantly Decreased in Preemptive Renal Transplant Patients.
abstract: OBJECTIVE
  Cardiovascular diseases and infections are the leading two causes of morbidity and mortality in end-stage renal disease (ESRD) patients. Kidney transplantation is the preferred method for renal replacement owing to better survival. There are reports of irreversibly damaged immune system in dialysis patients, which did not return to normal even after kidney transplantation. The neutrophil-lymphocyte ratio (NLR) is an easily applicable method for evaluation of inflammation. We hypothesized that preemptive kidney transplantation can improve inflammatory state compared with nonpreemptive recipients. To test our hypothesis, we retrospectively investigated pretransplant and posttransplant NLR and C-reactive protein (CRP) levels of ESRD patients and compared them with values in healthy controls.
  
  
  METHODS
  We retrospectively analyzed NLR, CRP, and other hematologic parameters of ESRD patients who were transplanted between January 2005 and January 2014 on the day of transplantation and at the end of first year. We grouped the patients as preemptive and nonpreemptive ones. We excluded patients with coronary artery disease, obesity, hypotension, hyperthyroidism, uncontrolled diabetes mellitus, hematologic or solid organ cancers, and active documented infection at any evaluation period.
  
  
  RESULTS
  We included 137 ESRD patient and 34 healthy control individual in our study. Of the 137 ESRD patients, 52 (38%) were transplanted preemptively. Of the patients, 85 were already on either hemodialysis or peritoneal dialysis therapy at the time of transplantation. The white blood cell count value of the patient and control group (7246.72 ± 1460.26 and 76661.76 ± 1286.29, respectively; P = .43), NLR of the control group was significantly lower than patient group (1.98 ± 0.94 and 3.47 ± 2.33, respectively; P = .007). The NLR of the preemptive group was decreased substantially at the end of first year posttransplantation, the NLR of the preemptive group was significantly lower than the nonpreemptive group (3.08 ± 1.32 and 3.71 ± 2.33; P = .01).
  
  
  CONCLUSIONS
  We showed that all ESRD patients had an increased inflammation rate according to CRP and NLR when compared with healthy controls. We also found that improvement of inflammatory state in preemptive patients is significantly better than nonpreemptive patients at the end of first year evaluation.
authors.affiliation: Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey. Electronic address: dr25erdem@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Çankaya
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Bilen
authors.affiliation: Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Keles
authors.affiliation: Department of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Uyanik
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Bilen
authors.affiliation: Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Aydınlı
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D009504:Neutrophils / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult