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

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.