Early post-reperfusion neutrophil dynamics after liver transplantation: Association with graft size

Patients with end-stage liver disease often exhibit impaired neutrophil function and have an elevated risk for perioperative infections. Liver transplantation (LT) restores hepatic function; however, perioperative neutrophil dynamics and their association with graft size remain unclear. We retrospectively analyzed 71 adult patients who underwent LT between January 2019 and June 2021. Leukocyte, neutrophil, and lymphocyte counts and the neutrophil-to-lymphocyte ratio were assessed at three intraoperative time points: beginning of surgery (BS), anhepatic phase (AP), and abdominal closure (AC), as well as on postoperative days (PODs) 1-3. The patients were stratified by graft-to-recipient weight ratio (GRWR < 1.0 vs. ≥ 1.0), and the correlations between GRWR and leukocyte parameters were evaluated. Neutrophil and leukocyte counts remained unchanged from the BS to AP and increased significantly after graft reperfusion (AC vs. BS: p < 0.01). Lymphocyte counts declined significantly during surgery. On POD 1, both neutrophil counts and their increases from BS correlated significantly with GRWR in the GRWR < 1.0 group (r_s = 0.424 and 0.442, respectively; both p < 0.01), although not in the GRWR ≥ 1.0 group. No postoperative infections were observed within 7 days. Graft reperfusion was associated with a robust increase in peripheral neutrophil counts, particularly in the recipients of smaller grafts. These findings suggest an association between graft size and early postoperative neutrophil dynamics, which may help interpret early immune responses after LT.