Multimarker Composite Prediction of Early Allograft Dysfunction and 90-Day Mortality After Liver Transplantation:...

Background/Object: Early allograft dysfunction (EAD) and 90-day mortality are major challenges after liver transplantation (LT). Combined predictive utility of the delta neutrophil index (DNI), lactate clearance, and C-reactive protein/albumin ratio (CAR) in the post-LT setting remains unexplored. Methods: We conducted a single-center retrospective cohort study of 548 adult elective LT recipients (January 2010-December 2023). Serial DNI, lactate clearance, CRP, albumin, bilirubin, and INR were measured during the first postoperative week. Multivariate logistic regression identified MELD score and five postoperative predictors of 90-day mortality: Results: DNI ≥ 2.5 at POD 7 (OR 8.42, 95% CI 3.56-19.92), lactate clearance < 15% at 6 h post-reperfusion (OR 4.65), CRP/albumin ratio ≥ 8.5 at POD 3 (OR 3.28), total bilirubin ≥ 10 mg/dL at POD 7 (OR 2.94), and INR ≥ 1.6 at POD 7 (OR 2.18). A five-variable postoperative DLC composite score (0-5 points) achieved an AUC of 0.876 (95% CI 0.831-0.921) for 90-day mortality, significantly outperforming DNI alone (AUC 0.742), MELD (AUC 0.663; both p < 0.001), and a bilirubin/INR subset of the Olthoff EAD criteria (AUC 0.784; p = 0.014). In a secondary concordance analysis, the DLC score showed concordance with patients meeting EAD criteria (AUC 0.854). Risk stratification produced 90-day mortality of 2.7%, 18.4%, and 55.3% for Low-, Intermediate-, and High-risk groups. Conclusions: The DLC score demonstrates promising internal performance for risk stratification within the first postoperative week and warrants prospective external validation prior to clinical adoption.