Early Post-Transplant Changes in Nutritional Status Predict Long-Term Graft Loss and Mortality

Area of Science:

• Nephrology
• Transplantation Immunology
• Nutritional Science

Background:

• Nutritional status significantly impacts kidney transplant outcomes.
• Longitudinal changes in nutritional indices and their prognostic value in kidney transplant recipients (KTRs) require further investigation.
• This study focuses on the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score.

Purpose of the Study:

• To evaluate the association between first-year changes in PNI and CONUT scores and long-term adverse outcomes in KTRs.
• To determine if early nutritional status deterioration predicts long-term graft survival and patient mortality.
• To assess the utility of PNI and CONUT for risk stratification in KTRs.

Main Methods:

• Retrospective cohort study of 352 adult KTRs with a median follow-up of 11.4 years.
• PNI and CONUT calculated pre-transplant and at one year post-transplant.
• Multivariable logistic regression used to analyze associations between nutritional index changes and composite outcomes (ESRD or death with functioning graft), adjusting for eGFR, rejection episodes, and urine PCR.

Main Results:

• Worsening PNI and CONUT scores in the first year post-transplant were independently associated with increased risk of adverse long-term outcomes (OR: 2.02 and 2.01, respectively).
• Higher first-year estimated glomerular filtration rate (eGFR) was linked to a reduced risk of adverse outcomes.
• Associations were stronger for graft loss and death-related outcomes, supporting the prognostic significance of early nutritional changes.

Conclusions:

• Early deterioration of nutritional status, as measured by PNI and CONUT changes within the first year, independently predicts adverse long-term outcomes in KTRs.
• Serial monitoring of PNI and CONUT offers a simple, cost-effective method for improving long-term risk stratification.
• Identifying KTRs with declining nutritional status can guide closer follow-up and personalized nutritional interventions.