The pretransplant neutrophil-lymphocyte ratio is associated with postreperfusion syndrome and short-term outcomes after paediatric living-donor liver transplantation.

Objective: The aim of this study was to evaluate whether the pretransplant neutrophil-lymphocyte ratio (NLR) is associated with postreperfusion syndrome (PRS) after paediatric living-donor liver transplantation (LDLT) and the impact of different pretransplant NLR values on short-term outcomes.

Methods: Clinical data from paediatric patients who underwent LDLT for biliary atresia were retrospectively analysed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of the pretransplant NLR for PRS. The paediatric patients were stratified into two cohorts according to the optimal cut-off value, and their perioperative clinical indices were subsequently compared.

Results: This retrospective study included 313 paediatric patients who had been diagnosed with biliary atresia. Based on ROC analysis, the area under the curve (AUC) of the NLR was 0.738, with a sensitivity of 73.1% and a specificity of 68.2% when predicting PRS. Paediatric patients were split into two groups according to the optimal NLR cut-off: NLR-Low (n = 158) and NLR-High (n = 155). Compared with the NLR-Low group, the NLR-High group had significantly more postoperative intensive care unit and hospitalisation days (p < 0.05). Furthermore, patients in the NLR-High group demonstrated a notably lower 1-year survival rate than their counterparts in the NLR-Low group did. An elevated NLR, a prolonged graft cold ischaemic time, and the occurrence of hypothermia before reperfusion are independent risk factors for PRS.

Conclusion: The pretransplant NLR is associated with postreperfusion syndrome in paediatric LDLT patients, and an elevated NLR is correlated with unfavourable short-term postoperative outcomes in paediatric patients after LDLT.