Controlling Nutritional Status Score and Early Posttransplant Outcomes: Infection Risk and Acute Rejection in Kidney...

Nutritional and immune status influence kidney transplant outcomes, yet the prognostic value of the Controlling Nutritional Status (CONUT) score remains unclear.

We retrospectively analyzed 129 adult kidney transplant recipients at a single center. Patients were stratified by pretransplant CONUT score into low (≤4) and high (≥5) groups. The primary endpoint was infection requiring hospitalization and intravenous (IV) antibiotics within 6 months posttransplant. Biopsy-proven acute rejection (BPAR) developing within the first 6 months was evaluated as a secondary outcome.

There were 48 (37.2%) patients in the CONUT ≥5 group and 81 (62.8%) patients in the CONUT ≤4 group. Infections developed in 56 patients during the post-transplant period. Infections occurred significantly more frequently in the high CONUT group (60.4% vs. 33.3%, p = .017), with longer infection-related hospitalization (median 18 vs. 10 days, p = .008). On multivariate logistic regression analysis, CONUT ≥5 group independently predicted infection (OR=2.64, 95% CI 1.06-6.59, p = .037). ROC analysis identified a cutoff of 4.5 (AUC 0.629, p = .037). BPAR developed in 29 patients. The incidence of BPAR was higher in the CONUT ≥5 group (35.4% vs. 14.8%, p = .016), while no significant differences were observed for chronic rejection or graft loss. Mean graft survival was 110.0 ± 10.1 months in CONUT ≥5 and 121.4 ± 7.2 months in CONUT ≤4 patients (p = .47).

Preoperative CONUT score may be an independent predictor of early serious infection after kidney transplantation. It may also be related to BPAR, which develops within 6 months. The CONUT score may serve as a simple and practical tool for infection and BPAR risk stratification in routine clinical practice.