Pre-Transplant Prognostic Nutritional Index Predicts Short-Term Outcomes after Liver Transplantation

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Conference Proceeding

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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.




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