C-Reactive Protein-Albumin-Lymphocyte Index, Prognostic Nutritional Index, and Glasgow Prognostic Score as Predictors of Acute Renal Allograft Rejection: A Comparative Analysis.

BACKGROUND: Acute renal allograft rejection remains a leading cause of graft loss despite advances in immunosuppressive therapy. Conventional predictors such as histopathology and immunologic markers have limitations in early detection. The C-reactive protein-albumin-lymphocyte (CALLY) index, Prognostic Nutritional Index (PNI) and Glasgow Prognostic Score (GPS) emerging inflammatory-nutritional markers, has shown prognostic value in oncology but has not been evaluated in renal transplantation. This study aimed to assess the predictive value of these indices for acute rejection after kidney transplantation. METHODS: This cohort included 59 adult renal transplant recipients between January 2015 and December 2024. Pretransplant laboratory parameters were used to calculate CALLY, PNI and Glasgow GPS. The primary endpoint was biopsy proven acute rejection within 12 months posttransplant. Logistic regression analyses identified independent predictors, and receiver operating characteristic (ROC) curves evaluated discriminative performance. RESULTS: Acute rejection occurred in 16 patients (27.1%). Compared with non-rejection cases, lower CALLY values were independently associated with acute rejection (OR = 0.083, 95% CI 0.010-0.650, P = .018) and showed superior discriminative performance (AUC = 0.968, 95% CI 0.925-1.000, P < .001) compared with PNI and GPS. CONCLUSIONS: Pretransplant CALLY index is a simple, inexpensive, and independent predictor of acute renal allograft rejection. Incorporating this immune-nutritional biomarker into pretransplant evaluation may improve early risk stratification and individualized management in kidney transplantation.