Construction of a diagnostic model for early-stage postoperative complications after liver transplantation and molecular mechanism research

Objectives This study aimed to identify risk factors, elucidate molecular mechanisms, and establish a prediction model for early complications following liver transplantation (LT). Methods This study analysed 99 patients who underwent their first orthotopic liver transplantation, stratified by Clavien-Dindo grade ≥III complications into complication (n=21) and noncomplication (n=78) groups, with intergroup comparisons of body composition and clinically relevant parameters. Univariate and multivariate logistic regression identified risk factors for posttransplant complications, culminating in the development of a predictive model for postoperative complications following LT. The discriminative ability and calibration of the model were assessed via receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and the Hosmer-Lemeshow test, while its clinical utility was evaluated via decision curve analysis (DCA). Gene expression profiles were analysed via array datasets obtained from the Gene Expression Omnibus (GEO) database. Results Multivariate logistic regression analysis revealed that the SMI, CONUT score, and MELD score were independent risk factors for Grade III or higher early postoperative complications following LT. A predictive model incorporating the SMI, CONUT score, and MELD score demonstrated excellent discriminative ability, with an area under the ROC curve (AUC) of 0.856. The Hosmer-Lemeshow test confirmed good model fit ( P =0.339). DCA demonstrated superior net benefit compared with default strategies across clinically relevant threshold probabilities. Transcriptomic and immune profiling revealed pro-inflammatory pathway activation and distinct immune cell alterations in hepatic ischemia-reperfusion injury (HIRI) following LT. Conclusion The predictive model incorporating the SMI, CONUT score, and MELD score as independent risk factors for Grade III or higher early post-LT complications showed high clinical utility, while molecular insights highlighted potential therapeutic targets for mitigating post-LT complications.