Clinical value and limitations of the preoperative C-reactive-protein-to-albumin ratio in predicting post-operative morbidity and mortality after deceased-donor liver transplantation: a retrospective single-centre study

Background Liver transplantation is still associated with a high risk of severe complications and postoperative mortality. This study examines the predictive value of the preoperative C-reactive-protein-to-albumin ratio (CAR) regarding perioperative morbidity and mortality in deceased-donor liver transplantation (DDLT) recipients. Methods In total, 390 DDLT recipients between 05/2010 and 03/2020 were eligible. Predictive abilities of CAR were examined through receiver operating characteristic curve (ROC) analyses. Groups were compared using parametric and non-parametric tests as appropriate. Independent risk factors for morbidity and mortality were identified using uni- and multivariable logistic regression analyses. Results A good predictive ability for CAR was shown regarding perioperative morbidity (comprehensive complication index ≥75, Clavien-Dindo score ≥4a) and 12-month mortality, with an ideal cut-off of CAR=26%. Patients with CAR>26% had significantly higher median CCI scores (60 vs. 43, p 26%, pre-OLT inpatient hospitalization (including ICU) and postoperative red blood cell transfusions as independent predictors of severe cumulative morbidity (CCI≥75). Conclusion Preoperative CAR might be a reliable additional tool to predict perioperative morbidity and mortality in DDLT recipients.