Preoperative C-reactive-protein-to-albumin ratio as a predictor of patient- and graft-survival after deceased-donor liver transplantation

Background Advances in immunosuppression have improved outcomes after deceased-donor liver transplantation (DDLT). However, patient factors still affect long-term survival and graft loss. This study examines the predictive value of preoperative C-reactive-protein-to-albumin ratio (CAR) regarding recipient survival (RS) and graft survival (GS) after DDLT.

Materials and methods This study included DDLT recipients between 2010-2023. Re-transplantations, split-liver transplantations and patients dying within 90 days were excluded. Receiver operating characteristic curve (ROC), area under the curve (AUC) and Youden Index (YI) analyses were used to define a CAR cut-off for the prediction of RS and GS. Survival analyses were carried out using Kaplan-Meier, log rank test, and Cox regression.

Results The 444 included patients had a mean RS of 110 months (95%CI 105-116 months) and GS of 106 months (95%CI 100-112 months). The best predictive ability of CAR was shown for 3-year RS (3YRS, AUC=0.67, p<0.001) and 3-year GS (3YGS, AUC=0.65, p<0.001), with CAR=41% being the best cut-off for both outcomes (YI 0.35 and 0.32, respectively). Patients with CAR≥41% had significantly lower mean 3YRS (30 vs. 34 months, p<0.001) and 3YGS (29 vs. 33 months, p<0.001). Cox regression analysis for CAR≥41% showed a hazard ratio of 3.78 (95% CI 2.19-6.53, p<0.001) for 3YRS and 3.11 (95% CI 1.93-5.01, p<0.001) for 3YGS.

Conclusion Higher preoperative CAR is associated with inferior patient and graft survival, and may serve as an additional tool for identifying patients at risk after DDLT.

Publication History

Article published online:
23 January 2024