Prognostic significance of dynamic changes in systemic inflammatory markers on mortality after liver transplantation: a retrospective cohort study

Abstract

Purpose: Liver transplantation (LT) is a risky but life-saving treatment for end-stage liver disease. Dynamic changes in systemic inflammation can inform disease progression and postoperative recovery. This retrospective study investigated the prognostic impact of these chronological changes in patients undergoing LT. Methods: Inflammatory statuses were assessed using the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) measured preoperatively (within 7 days before surgery) and postoperatively (between days 21 and 90, before any re-exploration). Their predictive performances for three-year postoperative mortality were evaluated. Using the best-performing index, the patients were stratified into normal (persistently low), elevated (low-to-high), normalized (high-to-low), and persistent (persistently high) groups, and associations with mortality were analyzed. Results: A total of 377 patients were included. Among inflammatory indices, the NLR had the highest mortality prediction accuracy. Patients grouped by pre-and postoperative NLR cutoffs (4.2 and 24.0) showed significant mortality differences, with stepwise risk increases from normal to normalized and persistent groups. The NLR-based group was an independent mortality predictor. Compared with the normal group, the normalized and persistent groups had higher mortality, prolonged ventilation, and longer intensive care unit (ICU) and hospital stays. Conclusion: Dynamic changes in systemic inflammation, reflected by pre-and postoperative NLR, were strongly associated with long-term mortality after LT. The NLR is a reliable, accessible inflammatory marker. Elevated preoperative NLR was associated with poor outcomes, with persistent postoperative elevation indicating a worse prognosis than normalization. NLR trajectory may help identify high-risk LT patients and guide postoperative care.