Controlling Nutritional Status Scores Predict Postoperative Acute Kidney Injury in Living Donor Liver Transplantation

Acute kidney injury (AKI) is a frequent complication after liver transplantation (LT), and malnutrition is a known risk factor. The Controlling Nutritional Status (CONUT) score, based on serum albumin, lymphocyte count, and cholesterol, has been associated with postoperative AKI in other surgeries, but its relevance to LT remains unclear. This study aimed to evaluate the utility of the CONUT score for predicting AKI in living donor LT (LDLT) recipients.

We retrospectively analyzed 480 patients who underwent LDLT from January 2012 to June 2023. The CONUT score was calculated using preoperative laboratory data. The primary outcome was AKI incidence, defined by KDIGO criteria, and compared across CONUT grades. Multivariate logistic regression was used to identify independent predictors of AKI. Secondary outcomes included early allograft dysfunction (EAD), hospital length of stay (LOS), 30-day and 1-year mortality, and postoperative model for end-stage liver disease (MELD) scores on days 1, 3, 5, and 7.

Of the 480 patients, 150 (31.3%) developed AKI. AKI incidence significantly differed by CONUT grade (p = 0.003). Higher CONUT grades were associated with longer ventilation time (p = 0.008), prolonged hospital LOS (p = 0.001), more frequent EAD (p < 0.001), and higher postoperative MELD scores (p = 0.01). The CONUT score was independently associated with AKI in multivariate analysis (OR 1.14, 95% CI 1.05-1.24, p = 0.001).

The CONUT score independently predicts postoperative AKI in LDLT and may be a useful tool for preoperative risk stratification and perioperative management.