Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation · 2025
Evaluation of the Neutrophil-to-Lymphocyte Ratio as a Biomarker for Baseline Lung Allograft Dysfunction and Acute Cellular Rejection after Lung Transplant.
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Hage René, Dubach Irina Lea, Steinack Carolin, Rosselli Zsófia, Schuurmans Macé M
Аннотация
OBJECTIVES: The neutrophil-to-lymphocyte ratio is an inexpensive and accessible inflammatory biomarker that reflects the balance between innate and adaptive immunity. This study evaluated whether perioperative or early posttransplant neutrophil-to-lymphocyte ratio predicts baseline lung allograft dysfunction or acute cellular rejection within the first year after lung transplant.
MATERIALS AND METHODS: In this single-center retros-pective cohort study, we analyzed 80 adult bilateral lung transplant recipients (transplanted in 2021-2023). Patients had peripheral blood neutrophil-to-lymphocyte ratio measured pretransplant and at 3, 6, 9, and 12 months posttransplant; bronchoalveolar lavage neutrophil-to-lymphocyte ratio was calculated from differential counts when available. We assessed associations between neutrophil-to-lymphocyte ratio, baseline lung allograft dysfunction, and acute cellular rejection within the first year with the Mann-Whitney U test, χ2 test, or Fisher exact test. We performed receiver operating characteristic analysis with Youden index-based cutoffs and multivariable logistic regression adjusted for baseline dysfunction, diagnosis group, and sex.
RESULTS: Peripheral blood neutrophil-to-lymphocyte ratio at 3, 6, 9, and 12 months posttransplant was consistently higher in patients with baseline dysfunction than in those without, but differences were not significant. Bronchoalveolar lavage neutrophil-to-lymphocyte ratio showed no group differences and substantial variability. Receiver operating characteristic analyses showed no discriminatory ability of neutrophil-to-lymphocyte ratio to predict acute rejection (area under the curve ≈ 0.5 across all time points), and seemingly high sensitivities and specificities at certain cutoffs were artifacts accompanied by negligible Youden indices. In multi-variable models, neither blood nor bronchiolar lavage neutrophil-to-lymphocyte ratio was independently associated with rejection (all P > .05). Median follow-up was 12 months.
CONCLUSIONS: Neutrophil-to-lymphocyte ratio did not discriminate baseline lung allograft dysfunction or acute rejection, with regression analyses showing no significance. Neutrophil-to-lymphocyte ratio lacks clinical utility as a standalone marker and, if used at all, should be embedded within multimodal surveillance frameworks.
MATERIALS AND METHODS: In this single-center retros-pective cohort study, we analyzed 80 adult bilateral lung transplant recipients (transplanted in 2021-2023). Patients had peripheral blood neutrophil-to-lymphocyte ratio measured pretransplant and at 3, 6, 9, and 12 months posttransplant; bronchoalveolar lavage neutrophil-to-lymphocyte ratio was calculated from differential counts when available. We assessed associations between neutrophil-to-lymphocyte ratio, baseline lung allograft dysfunction, and acute cellular rejection within the first year with the Mann-Whitney U test, χ2 test, or Fisher exact test. We performed receiver operating characteristic analysis with Youden index-based cutoffs and multivariable logistic regression adjusted for baseline dysfunction, diagnosis group, and sex.
RESULTS: Peripheral blood neutrophil-to-lymphocyte ratio at 3, 6, 9, and 12 months posttransplant was consistently higher in patients with baseline dysfunction than in those without, but differences were not significant. Bronchoalveolar lavage neutrophil-to-lymphocyte ratio showed no group differences and substantial variability. Receiver operating characteristic analyses showed no discriminatory ability of neutrophil-to-lymphocyte ratio to predict acute rejection (area under the curve ≈ 0.5 across all time points), and seemingly high sensitivities and specificities at certain cutoffs were artifacts accompanied by negligible Youden indices. In multi-variable models, neither blood nor bronchiolar lavage neutrophil-to-lymphocyte ratio was independently associated with rejection (all P > .05). Median follow-up was 12 months.
CONCLUSIONS: Neutrophil-to-lymphocyte ratio did not discriminate baseline lung allograft dysfunction or acute rejection, with regression analyses showing no significance. Neutrophil-to-lymphocyte ratio lacks clinical utility as a standalone marker and, if used at all, should be embedded within multimodal surveillance frameworks.