Comparison of different preoperative objective nutritional indices for evaluating 30-d mortality and complications after liver transplantation

Abstract

BACKGROUND The nutritional status is closely related to the prognosis of liver transplant recipients, but few studies have reported the role of preoperative objective nutritional indices in predicting liver transplant outcomes. AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation (LT). METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022. RESULTS This study identified several independent risk factors associated with 30-d mortality, including blood loss, the prognostic nutritional index (PNI), the nutritional risk index (NRI), and the control nutritional status. The 30-d mortality rate was 8.6%. Blood loss, the NRI, and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications. The NRI achieved the highest prediction values for 30-d mortality [area under the curve (AUC) = 0.861, P < 0.001] and severe complications (AUC = 0.643, P = 0.011). Compared to those in the high NRI group, the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels, as well as higher alanine aminotransferase and total bilirubin levels, Model for End-stage Liver Disease scores and prothrombin time (P < 0.05). Furthermore, the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding, primary graft nonfunction, and mortality. CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT. The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.