Change in lymphocyte to neutrophil ratio predicts acute rejection after heart transplantation

Aims Most immunosuppressive drugs provide targeted immunosuppression by selective inhibition of lymphocyte activation and proliferation. This study evaluated whether a change in the lymphocyte to neutrophil ratio (LNR) is related to acute rejection. Methods In 74 cardiac transplant recipients peripheral blood lymphocyte and neutrophil counts were measured soon after (baseline) and three, six, and 12 months after heart transplantation. The primary endpoint was the incidence of acute rejection. Results Significant acute rejection after heart transplantation occurred in 20 patients (27%) during a median follow-up of 49.4 [IQR 37.4–61.1] months. LNR significantly increased over time (0.1149 ± 0.1354 at baseline, 0.2330 ± 0.2266 at 3 months, 0.2961 ± 0.2849 at 6 months, and 0.3521 ± 0.2383 at 12 months; P < 0.001), especially during the first 3 months in the group without acute rejection. The area under the curve of the change in LNR during the first three months (ΔLNR) for acute rejection was 0.565 (95% CI 0.420 to 0.710, P = 0.380) on ROC curve analysis. The best cutoff value of Δ LNR to differentiate those with and without acute rejection was ≤ 0.046 by ROC curve analysis. Kaplan-Meier analysis revealed that the low ΔLNR group (≤ 0.046) had a significantly higher rate of acute rejection than the high ΔLNR group (> 0.046) (37.5% vs. 19.0%, log-rank: P = 0.0358). The low ΔLNR for the first 3 months was an independent predictor of clinically significant acute rejection after adjusting for cytomegalovirus donor seropositive and recipient seronegative. Conclusions The results of this study suggest that ΔLNR over the first 3 months after heart transplantation is a strong and independent predictor of acute rejection after heart transplantation. ΔLNR can be used as an early biomarker for predicting of acute rejection after heart transplantation.