Pre-Transplant Prognostic Nutritional Index Predicts Short-Term Outcomes after Liver Transplantation
Lisznyai E, Kitajima T, Delvecchio K, Mohamed A, Yeddula S, Shamaa T, Ivanics T, Collins K, Rizzari M, Yoshida A, Abouljoud M, and Nagai S. Pre-Transplant Prognostic Nutritional Index Predicts Short-Term Outcomes after Liver Transplantation. Am J Transplant 2021; 21(SUPPL 1):13-14.
Am J Transplant
The prognostic nutritional index (PNI) is a serum marker of nutrition and inflammation. PNI previously predicted outcomes in liver transplant (LT) patients with recurrence of hepatocellular carcinoma. However, efficacy of PNI to predict post-LT outcomes is unknown. We hypothesized pre-transplant PNI would predict short-term post-LT outcomes in deceased donor liver transplant (DDLT) patients. 451 patients underwent primary DDLT between 2013-2018 at our center. Re-transplants, multi-organ transplants and living donor liver transplants were excluded. Pre-transplant PNI = (10)∗[albumin (g/dL)] + (0.005)∗[Total Lymphocyte Count (/μL)]. PNI was analyzed as both a continuous and categorical variable. ROC curves yielded an optimal PNI cut-off of 35 to compare short-term outcomes between PNI≥35 and PNI<35 cohorts. Risk factors for patient death within 1-year were analyzed using Cox regression models and adjusted by recipient factors at LT. Multivariable analysis associated PNI with 1-year survival as a continuous variable (HR=0.94; 95% CI=0.90-0.98; p=0.007). Of 451 patients, 215 (47.7%) had PNI<35. Pre-LT MELD score was higher in PNI<35 (22 vs. 19; p=0.028). Recipient age, gender, BMI, rates of diabetes mellitus, donor age and donors after cardiac death were equivocal. PNI<35 demonstrated lower 1-year survival (89.6% vs. 95.2%; p=0.026, Figure A). After risk adjustment, PNI<35 showed higher 6-month (HR=2.44; p=0.047) and 1-year death risk (HR=2.47; p=0.018). Multivariable analysis revealed PNI<35 at LT was an independent risk factor for patient death within 1 year (HR=2.37; p=0.023, Figure B). Lower pre-transplant PNI portended worse short-term survival in DDLT patients. PNI may be useful in evaluating pre-transplant nutritional status to optimize LT outcomes.