Background: Biological markers such as the pre-operative neutrophil to lymphocyte ratio (NLR) have been suggested to be valuable indicators of recurrence and overall survival after liver transplantation for HCC. While some groups have been able to demonstrate the significance of this pre-operative prognostic factor, other groups have disputed its value. This study inspected the relationship of NLR to other well-known prognostic factors for overall survival (OS) and recurrence.

Methods: A total of 423 patients undergoing liver transplant for HCC were identified between 2002 and 2014. Values for NLR, MELD, AFP, and tumor morphology were collected at multiple time points from the time of listing until transplant. The prognostic value of a high NLR (>5) was assessed using Cox proportional hazard models, Kaplan-Meier method, and histograms.

Results: There were 99 (23.4%) patients with a high NLR. Kaplan-Meier curves showed that a high NLR was associated with a lower overall survival and a higher rate of recurrence (P=.027 OS, P=.011 Recurrence). Multivariate analysis showed that NLR was not a statistically significant predictor of overall survival (HR=1.39 P=.13) or recurrence (HR=1.4 P=.1) when controlling for other important factors such as MELD. Visualization of changes in MELD-Na and NLR from the time of listing until LT showed similar trends and was mildly correlated (R=.26).

Conclusion: Pre-LT NLR was a significant indicator of OS and recurrence in patients with HCC seeking LT when viewed as the sole factor. Further investigation showed that pre-LT NLR is confounded by MELD-Na.

CITATION INFORMATION: McVey J., Sasaki K., Dan F., Cristiano Q., Koji H., Charles M., Federico A. The Neutrophil to Lymphocyte Ratio is Confounded by MELD in Hepatocellular Carcinoma Patients Undergoing Liver Transplantation Am J Transplant. 2017;17 (suppl 3).

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