Prognostic value of neutrophil percentage-to-albumin ratio as an adjunct parameter in liver transplantation: A cohort study

End-stage liver disease continues to present a major clinical challenge, for which liver transplantation (LT) remains the only treatment capable of restoring long-term survival and organ function. Despite advancements in perioperative care and surgical techniques, predicting post-transplant outcomes remains an area of considerable uncertainty. The neutrophil percentage-to-albumin ratio (NPAR), derived from standard blood tests, has emerged as a marker reflecting both systemic inflammation and nutritional status. While NPAR has shown prognostic potential in various liver-related conditions, its role in LT has not been fully clarified. We retrospectively analyzed data from 167 adult patients who underwent LT between 2012 and 2022. Patients were stratified by post-transplant survival status. Preoperative variables - including serum albumin, model for end-stage liver disease (MELD) score, and NPAR - were compared between survivor and non-survivor groups. Receiver operating characteristic analyses were performed to evaluate the predictive performance of these parameters individually and in combination. Significant differences in albumin, total bilirubin, MELD score, and NPAR were observed between survivor and non-survivor groups (P < .05). Individually, both NPAR and MELD demonstrated limited predictive value (AUC = 0.387 and 0.383, respectively). However, their combined application significantly improved discriminatory ability (AUC = 0.654, P = .007), suggesting a complementary interaction. Although NPAR alone is not a strong standalone predictor of post-transplant survival, its integration with the MELD score enhances prognostic accuracy. These findings support the role of NPAR as an adjunct parameter in refining pre-transplant risk assessment.