The role of erythrocyte distribution width, platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in the development of graft rejection after keratoplasty

Objective: The aim of this research is to evaluate the pre-surgical Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Red Cell Distribution Width (RDW) in patients undergoing rekeratoplasty compared to control subjects. Method: Penetrating keratoplasty (PKP) cases performed between 2013 and 2023 were evaluated retrospectively. The follow-up period was determined as at least 6 months. The first group consisted of 31 patients who underwent rekeratoplasty due to corneal graft rejection after PKP, and the second group consisted of 31 patients with the same diagnosis who did not experience graft rejection during their follow-up after PKP. NLR, PLR and RDW values from the preoperative complete blood count results of all patients were included in the study. Results: Upon demographic analysis, it was evident that although no notable age discrepancy existed between the two categories, the prevalence of rekeratoplasty was considerably higher in males. Primary diagnoses of the disease did not appear to have a significant impact on the risk of rejection. There was no observable correlation between serum NLR, PLR and RDW levels and graft rejection. Nevertheless, a notable association was detected between RDW and the duration until the occurrence of the initial rejection episode. Conclusion: High RDW value, which is an indicator of systemic inflammatory state, was found to be associated with the time to first rejection reaction in corneal transplant patients and graft rejection patients compared to controls, as in many diseases. RDW in terms of rejection reaction risk prediction and prognosis; it can be used as a useful, cheap and practical parameter.