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Volume: 17 Issue: 1 February 2019


Letter to the Editor Regarding "Neutrophil-to-Lymphocyte Ratio in Renal Transplant Patients"

Dear Editor:

We read with interest the recent article “Neutrophil-to-Lymphocyte Ratio in Renal Transplant Patients” by Mari Ohtaka and colleagues.1 In their study, the authors aimed to expound the dynamic changes of neutrophil-to-lymphocyte ratio (NLR) after renal transplant and analyze the correlation between NLR and malignant disease by exploring 4 cases in depth. The authors concluded that NLR reveals dramatic differences at 1 and 3 months after renal transplant and that observing NLR in renal transplant patients could help to detect malignant disease. I appreciate the efforts of this meticulous study by the authors. However, a word of caution is advised before we rush into making definite conclusions. I would like to express some concerns through your prestigious journal.

First, NLR varies with age, sex, and body mass index of patients.2 The original disease, source of kidney donation, and the therapeutic methods before and after transplant are all involved in the dynamic changes of NLR. We need to determine whether these factors affect the level of NLR to reach a more accurate conclusion.

Second, the explicit relationship between malignant disease and renal transplant has not been illuminated. Neutrophil-to-lymphocyte ratio has been reported to be related to the prognosis of renal transplant,3 malignant disease,4 and immunosuppressive therapy5 individually in previous studies. Whether the malignant disease concerns a primary tumor or secondary tumor after renal transplant remains unclear. We can only deduce that NLR is related to malignant disease but not with transplant-induced malignancy.

Third, the clinical cases lacked persuasion to support the conclusion that the NLR of patients with malignant disease after renal transplant continues to increase. In patients 3 and 4, NLR was stable and was not higher than patient 2, showing no significant difference from other patients with stable condition. It is hard to assign an NLR cut-off value to warn of risk of malignant disease. Except for patient 3, the NLR stayed at a low level for almost 1 year, thus not raising early suspicion about impending com­plications following transplant.

Finally, I would like to conclude that reaching true insight of the significance of NLR in renal transplant patients is still a long way off. Future prospective trials are required before making a definite conclusion.


  1. Ohtaka M, Kawahara T, Takamoto D, et al. Neutrophil-to-lymphocyte ratio in renal transplant patients. Exp Clin Transplant. 2018;16(5):546-549.
    CrossRef - PubMed
  2. Li J, Chen Q, Luo X, et al. Neutrophil-to-lymphocyte ratio positively correlates to age in healthy population. J Clin Lab Anal. 2015;29(6):437-443.
    CrossRef - PubMed
  3. Hogendorf P, Suska A, Skulimowski A, et al. Neutrophil-lymphocyte ratio and creatinine reduction ratio predict good early graft function among adult cadaveric donor renal transplant recipients. Single institution series. Pol Przegl Chir. 2018;90(2):28-33.
    CrossRef - PubMed
  4. Lai Q, Castro Santa E, Rico Juri JM, Pinheiro RS, Lerut J. Neutrophil and platelet-to-lymphocyte ratio as new predictors of dropout and recurrence after liver transplantation for hepatocellular cancer. Transpl Int. 2014;27(1):32-41.
    CrossRef - PubMed
  5. Santoni M, De Giorgi U, Iacovelli R, et al. Pre-treatment neutrophil-to-lymphocyte ratio may be associated with the outcome in patients treated with everolimus for metastatic renal cell carcinoma. Br J Cancer. 2013;109(7):1755-1759.
    CrossRef - PubMed

Volume : 17
Issue : 1
Pages : 128 - 128
DOI : 10.6002/ect.2018.0217


From the 1Plastic Surgery for Burns Department, Affiliated Hospital of Jiangsu University, Zhenjiang, China; and the 2Department of Pediatric Surgery, Wuxi Children’s Hospital, Wuxi, China
Acknowledgements: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this research was supported by Wuxi Young Medical Talents (grant No. QNRC023) and the Medical Innovation Team of Jiangsu Province (grant No.CXTDB2017016). The authors have no conflicts of interest to declare.
Corresponding author: Yisen Zhang, Department of Pediatric Surgery, Wuxi Children’s Hospital, Qingyang Street, Wuxi, China
Phone: +86 17802503639