Session Name: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Date & Time: None. Available on demand.
*Purpose: To understand the importance of pre-transplant nutritional status in optimizing liver transplant outcomes.
*Methods: The prognostic nutritional index (PNI) is a serum marker of nutrition and inflammation. 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 cutoff 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.
*Results: 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. MELD score at time of transplant was higher in PNI<35 (22 vs. 19; p=0.028). Recipient age, gender, BMI, donor age, rates of diabetes mellitus 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 risk of 6-month (HR=2.44; p=0.047) and 1-year death (HR=2.47; p=0.018). Multivariable analysis revealed PNI<35 at LT (HR=2.37; p=0.023) was an independent risk factor for patient death within 1 year (Figure B).
*Conclusions: Lower pre-transplant PNI portended worse short-term survival in DDLT patients. PNI may be useful in evaluating pre-transplant nutritional status and optimizing LT outcomes.
To cite this abstract in AMA style:Lisznyai E, Kitajima T, Delvecchio K, Mohamed A, Yeddula S, Shamaa T, Ivanics T, Collins K, Rizzari M, Yoshida A, Abouljoud M, Nagai S. Pre-transplant Prognostic Nutritional Index Predicts Short-term Outcomes After Liver Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/pre-transplant-prognostic%e2%80%af-nutritional%e2%80%af-index%e2%80%af-predicts-%e2%80%afshort-term%e2%80%af-outcomes%e2%80%af-after-%e2%80%afliver-transplantation/. Accessed September 19, 2021.
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