Clinical impact of the prognostic nutritional index at listing and immediately before surgery in lung transplantation

PURPOSE: The prognostic nutritional index (PNI), which is calculated from the serum albumin concentrations and lymphocyte counts, predicts the outcomes in lung transplantation (LT). This study aimed to investigate the optimal timing for assessing PNI before LT. METHODS: We analyzed 140 brain-dead LT recipients (2015-2023) in this study. The PNI was calculated at the time of transplant listing and immediately before LT. Using a cutoff value of 45, the patients were classified into high/low PNI groups and compared for overall survival. Changes in the PNI trajectories were analyzed. RESULTS: Multivariable analyses showed that a low PNI independently predicted mortality at listing (hazard ratio [HR], 2.82; 95% confidence interval [CI], 1.44-5.53; P = 0.003) and before LT (HR, 2.44; 95% CI, 1.25-4.77; P = 0.009). Patients with a persistently low PNI had a worse survival than those with a persistently high PNI (HR, 3.58; 95% CI, 1.62-7.91; P = 0.002), whereas an improvement in the PNI after listing was not significantly associated with survival. CONCLUSION: PNI at both time points significantly predicted post-transplant outcomes. A trajectory analysis highlights the importance of nutritional assessment before listing, although larger studies are required to clarify the effects of nutritional changes after listing.