The Role of Baseline Systemic Inflammatory Indices Predicting Long-Term Mortality in Kidney Transplant Recipients

Kidney transplantation (KT) improves survival in patients with end-stage renal disease; however, long-term mortality among kidney transplant recipients (KTRs) remains higher than in the general population. Persistent systemic inflammation may contribute to adverse long-term outcomes. We aimed to evaluate the association between baseline systemic inflammatory indices and long-term mortality in KTRs.

This retrospective cohort study included 353 adult KTRs. Baseline Systemic Inflammation Response Index (SIRI), Systemic Immune-Inflammation Index (SII), and Pan-Immune-Inflammation Value (PVI) were calculated using pretransplant complete blood count parameters. The primary outcome was long-term all-cause mortality. Prognostic performance was assessed using receiver operating characteristic analysis, and independent predictors were identified by multivariate logistic regression. Longitudinal changes in SIRI were evaluated up to 5 years post-transplant.

During a mean follow-up of 11.4 ± 6.0 years, 49 patients (13.9%) died. Baseline SIRI was significantly higher in non-survivors than in survivors (2.70 vs 1.86; p = .02), whereas SII and PVI were not associated with mortality. SIRI showed modest discriminatory ability for mortality prediction (AUC = 0.602; p = .022). In multivariate analysis, baseline SIRI ≥ 1.79 and age ≥ 50 years were independently associated with mortality.

Baseline SIRI was independently associated with long-term mortality in KTRs and outperformed other CBC-derived inflammatory indices, suggesting potential value for pretransplant risk stratification.