Preoperative SII and LAR as a New Predictor for Early Allograft Dysfunction in Adult Living Donar liver transplantion

Objective: To assess whether preoperative Systemic Immune-Inflammation Index (SII) and Lymphocyte-to-Albumin Ratio (LAR) predict Early Allograft Dysfunction (EAD) after Adult Living Donor Liver Transplantation (ALDLT). Methods: We retrospectively analyzed 136 ALDLT recipients, classifying them into EAD (n = 46) and non-EAD (n = 90) groups. Preoperative SII and LAR were calculated. Univariate and multivariate logistic regression were used to identified independent risk factors. A combined prediction model was developed, and its performance was assessed using ROC curve and Kaplan-Meier survival analysis. Results: The EAD incidence was 33.8%. Multivariate analysis confirmed preoperative SII, LAR, and MELD 3.0 as independent risk factors. The individual AUCs for for SII, LAR, and MELD 3.0 in predicting EAD were 0.612, 0.590, and 0.653, respectively. A model combining SII, LAR, and age showed superior predictive ability (AUC = 0.706). Based on the model's cutoff, patients were stratified into high-risk (n = 36) and low-risk (n = 100) groups. Patients in the high-risk group had a 2.83-fold higher incidence of EAD and a significantly worse early post-operative survival. Conclusion: Preoperative SII and LAR are independent predictors of EAD in ALDLT. The new combined model effectively stratifies patient risk, which may provide a basis for personalized clinical intervention.