To explore the effect of platelet-lymphocyte ratio (PLR) on prolonged mechanical ventilation (PMV) and prognosis after liver transplantation with donation after cardiac death (DCD).

A total of 93 adult recipients who received DCD liver transplantation in the First Affiliated Hospital with Nanjing Medical University from January to December 2018 were included, and their clinical information was retrospectively analyzed. The patients were divided into a PMV group (mechanical ventilation time > 24 h, n = 38) and a control group (mechanical ventilation time ≤ 24 h, n = 55). Clinical data on preoperative, intraoperative and postoperative outcomes and prognosis were compared between these two groups, and those with statistical significance were selected for multivariate Logistic regression analysis.

PMV occurred in 38 of the 93 liver transplant recipients, with an incidence of 40.9%. Besides the preoperative hemoglobin, activated partial thromboplastin time (APTT), fibrinogen, Child-Pugh score, operation duration, intraoperative bleeding volume, and transfusion volumes of erythrocyte suspension and cryoprecipitate, there were also statistically significant differences in the PLR, fibrinogen, APTT, blood urea nitrogen and platelet count within the first hour, acute physiology and chronic health evaluation (APACHE) Ⅱ score within 24 h, and next day PLR in the ICU after liver transplantation between the two groups (all P < 0.05). The above indexes were included in multivariate Logistic regression analysis, which suggested that the PLR within the first hour [odds ratio (OR) = 0.994, 95% confidence interval (CI) (0.988, 1.000), P = 0.043] and APACHE Ⅱ score within 24 h [OR = 1.270, 95%CI (1.006, 1.604), P = 0.045] in the ICU after liver transplantation were influence factors for PMV after liver transplantation. The postoperative in-hospital mortality of PMV group was 18.4% (7 / 38), significantly higher than that of control group which was 0% (0 / 55) (P = 0.001). The postoperative ICU length of stay [5.0 (3.0, 10.8) d vs. 2.0 (2.0, 3.0) d, Z = 5.598, P < 0.001] and mechanical ventilation time [91.0 (48.8, 171.8) h vs. 20.0 (17.0, 24.0) h, Z = 8.180, P < 0.001] of PMV group were significantly longer than those of control group.

The PLR within the first hour and APACHE Ⅱ score within 24 h in the ICU after liver transplantation are influence factors for PMV after DCD liver transplantation.