Postoperative Neutrophil to Lymphocyte and Platelet Ratio as a Predictor of Delayed Graft Function

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Background: Development of delayed graft function (DGF) has been associated with worse short and long-term outcomes after kidney transplantation (KT). Inflammation plays a key role in the development of DGF. The neutrophil to lymphocyte and platelet (NLP) ratio is an affordable biomarker of systemic inflammation easily determined from a complete blood cell count. We aimed to assess whether postoperative NLP ratio may be used as an early predictor of DGF in KT patients. Methods: We conducted a retrospective cohort of adult patients submitted to KT at our unit, between 1 January 2010 and 31 December 2020. NLP was calculated at 24h post-KT. Primary outcome was development of DGF. Logistic regression was calculated to determine significant factors which may have contributed to DGF. Results: We included 527 patients with a mean age of 49.9 ± 12.8 years and the majority were male (n=308, 58.4%). Patients had been under renal replacement therapy for 5.9±4 years. In 47.8% of patients expanded criteria donors were used, and in 3.6% non-heart-beating donors. DGF occurred in 17.8% of patients. Use of rabbit anti-thymocyte immunoglobulin for induction therapy was similar between groups (DGF vs. early graft function, p=0.078). Mean post-KT NLP was 26.4±3.5 and, as expected, was higher in patients submitted to induction therapy with lymphocyte depleting antibodies (50.2±40.3 vs. 11.9±7.4 in patients treated with basiliximab, p<0.001), but it was found to be higher even before KT (and thereby before induction therapy) (5.2±1.8 in patients treated with rabbit anti-thymocyte immunoglobulin vs. 1.9±1.2 with basiliximab, p=0.001) and not predictive of DGF. Grafts from non-heart-beating donors (OR 13.989, 95% CI 4.741, 41.274, p=0.000), longer warm ischemia time (OR 1.035, 95% CI 1.007, 1.064, p=0.014) and higher NLP ratio 24 hours after transplantation (OR 1.009, 95% CI 1.002, 1.016, p=0.015) were independent predictors of DGF. Creatinine at discharge (3.3±2.2 versus 1.4±0.5, p=0.000) was higher in patients with DGF. Conclusions: In our cohort, a higher NLP ratio at 24 hours after KT was an independent predictor of DGF. This reflects the impact of inflammation on KT outcomes and highlights the role of the NLP ratio as a sensitive marker of systemic inflammatory response after KT.

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