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


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Research Mentor Name

Shunji Nagai

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Institution / Department

Henry Ford Transplant Institute

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Research Abstract

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Level of Research



Introduction: 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.

Methods: 451 patients underwent primary DDLT between 2013-2018 at Henry Ford Hospital. 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 PNILT.

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 PNIFigure A). After risk adjustment, PNI(HR=2.44; p=0.047) and 1-year death (HR=2.47; p=0.018). Multivariable analysis revealed PNI(HR=2.37; p=0.023) was an independent risk factor for patient death within 1 year (Figure B).

Conclusion: 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.


Medicine and Health Sciences | Surgery

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