Association of Pretransplant Neutrophil-to-Lymphocyte Ratio With Major Adverse Cardiovascular Events in Kidney Transplant Recipients With Normal C-Reactive Protein Levels.

PURPOSE: Cardiovascular disease is a leading cause of mortality in kidney transplant recipients. Systemic inflammation contributes to cardiovascular risk, but subclinical inflammation may not be reliably detected by C-reactive protein (CRP). The neutrophil-to-lymphocyte ratio is a simple marker of systemic inflammation associated with adverse cardiovascular outcomes. METHODS: A total of 157 kidney transplant recipients with normal CRP levels (≤ 3 mg/L) were included. Major adverse cardiovascular events (MACE) were defined as myocardial infarction, coronary revascularization, or stroke. Associations between NLR and outcomes were assessed using univariate logistic regression and receiver operating characteristic (ROC) analysis. RESULTS: During a mean follow-up of 57.9 months, 27 patients (17.2%) experienced MACE and 19 patients (12.1%) died. Patients with MACE were older and more frequently had pre-existing cardiovascular disease. Higher pretransplant NLR significantly associated with post-transplant MACE (OR 1.21; 95% CI 1.03-1.45; p = .03). ROC analysis yielded an AUC of 0.629 and identified an optimal cut-off value of 3.42. Patients with NLR > 3.42 showed a higher incidence of MACE compared with those with lower values (27.9% vs 10.4%; p = < .01). No significant association was observed between NLR and all-cause mortality. CONCLUSIONS: Elevated pretransplant NLR is associated with post-transplant cardiovascular events despite normal CRP levels.