Pretransplant Malnutrition Risk Score: A Simple and Useful Tool for Predicting Kidney Transplant Outcomes

Abstract

Background: The prevalence of malnourished patients before transplantation and the influence of malnutrition on graft and patient outcomes remain underestimated, despite being associated with higher postoperative morbidity and mortality. This study aimed to develop an easy nutritional screening tool and evaluate the impact of the nutritional status on clinical outcome, graft survival and mortality risk in kidney transplant (KT) patients.Methods: In this retrospective cohort study including 451 KT patients, we developed a score by using anthropometric, clinical, and laboratory measures performed in the pretransplant evaluation. The sum of all its components ranged from 0 to 12 points. The patients were stratified into 3 groups: G1 (0 or 1 point)=low risk, G2 (2 to 4 points)=moderate risk, and G3 (>5 points)=high risk of malnutrition. Results: Stratifying the patients, G1, G2, and G3 were composed of 90, 292, and 69 patients, respectively. Patients from G1 maintained the lowest serum creatinine levels at hospital discharge when compared with others (p=0.012). The incidence of infection in the patients from G3 had was higher than patients from G1 and G2 (p=0.030). G3 recipients showed worse GS than G1 patients (p=0.044). G3 patients showed almost threefold higher risk for graft loss (HR 2.94, 95% CI 1.084-7.996). Conclusions: KT patients with higher malnutrition risk score was associated with worse outcomes and graft survival. The nutritional screening tool is easy to be used in clinical practice to evaluate the patient in preparation for KT.