Prognostic Value of the Preoperative HALP Score for Survival in Non-Malignant Liver Transplant Recipients

Background/Objectives: The HALP score is a simple immunonutritional index calculated from routine preoperative hemoglobin, albumin, lymphocyte, and platelet values. We evaluated its association with mortality after liver transplantation for non-malignant indications and its prognostic contribution when considered with the Model for End-stage Liver Disease (MELD) score. Methods: We retrospectively analyzed 194 adults who underwent liver transplantation for non-malignant disease at a single center between January 2015 and January 2025. The primary outcome was all-cause post-transplant death. The cohort-derived HALP threshold was used for exploratory Kaplan-Meier and Cox analyses, while continuous HALP was examined in sensitivity analyses. Censoring-adjusted cumulative/dynamic ROC analyses evaluated discrimination at 30 days, 90 days, 1 year, and 3 years. Results: Over a median observed follow-up of 1108 days, 43 recipients (22.2%) died. Non-survivors had lower HALP values than survivors [0.52 (0.39-0.67) vs. 0.77 (0.54-1.04); p < 0.001]. HALP had the highest observed conventional AUC among the evaluated markers for overall mortality (AUC 0.735; 95% CI 0.657-0.814); pairwise AUC differences were not formally tested. The exploratory threshold was 0.6786. Mortality occurred in 36.3% of the low-HALP group and 9.7% of the high-HALP group. After adjustment for MELD and albumin, high versus low HALP remained associated with lower mortality (HR 0.239; 95% CI 0.116-0.493; p < 0.001). HALP also showed consistent time-dependent discrimination across the four evaluated horizons (AUC 0.713-0.738). Conclusions: Lower preoperative HALP was associated with higher post-transplant mortality in this non-malignant liver transplant cohort. HALP may provide complementary risk information, but the cohort-derived threshold requires independent external validation before clinical use.