Prognostic Impact of the C‐Reactive Protein–Albumin–Lymphocyte ( CALLY ) Index in Patients With Hepatocellular Carcinoma Undergoing Living Donor Liver Transplantation

ABSTRACT Background The C‐reactive protein–albumin–lymphocyte (CALLY) index reflects systemic inflammation, nutritional status, and immune competence. However, its prognostic significance in patients undergoing living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) remains unclear. Methods We retrospectively analyzed 239 patients with HCC who underwent LDLT. Prognostic performance, clinicopathological associations, and post‐transplant outcomes were evaluated using Cox regression, competing‐risk analysis, and internal validation. Results The 5‐year area under the curve for the CALLY index was 0.65 (95% confidence interval [CI], 0.53–0.77). Low CALLY was associated with worse overall survival ( p = 0.0134) and higher 1‐year mortality (12.7% vs. 4.0%, p = 0.0153). In multivariable analysis, low CALLY was associated with higher mortality (hazard ratio, 2.17; 95% CI, 1.20–3.93; p = 0.0099). Adding CALLY to the clinical model increased the apparent C‐index from 0.513 to 0.612 (ΔC‐index, 0.099; p = 0.042), although calibration was similar. CALLY was not associated with HCC recurrence, whereas elevated PIVKA‐II was. Conclusion Low CALLY was associated with higher mortality after LDLT for HCC and appears to reflect recipient condition rather than recurrence risk. It may be useful for preoperative risk assessment.