Controlling Nutritional Status Score and Early Posttransplant Outcomes: Infection Risk and Acute Rejection in Kidney Transplant Recipients.

BACKGROUND: Nutritional and immune status influence kidney transplant outcomes, yet the prognostic value of the Controlling Nutritional Status (CONUT) score remains unclear. MATERIALS AND METHODS: We retrospectively analyzed 129 adult kidney transplant recipients at a single center. Patients were stratified by pretransplant CONUT score into low (≤4) and high (≥5) groups. The primary endpoint was infection requiring hospitalization and intravenous (IV) antibiotics within 6 months posttransplant. Biopsy-proven acute rejection (BPAR) developing within the first 6 months was evaluated as a secondary outcome. RESULTS: There were 48 (37.2%) patients in the CONUT ≥5 group and 81 (62.8%) patients in the CONUT ≤4 group. Infections developed in 56 patients during the post-transplant period. Infections occurred significantly more frequently in the high CONUT group (60.4% vs. 33.3%, p = .017), with longer infection-related hospitalization (median 18 vs. 10 days, p = .008). On multivariate logistic regression analysis, CONUT ≥5 group independently predicted infection (OR=2.64, 95% CI 1.06-6.59, p = .037). ROC analysis identified a cutoff of 4.5 (AUC 0.629, p = .037). BPAR developed in 29 patients. The incidence of BPAR was higher in the CONUT ≥5 group (35.4% vs. 14.8%, p = .016), while no significant differences were observed for chronic rejection or graft loss. Mean graft survival was 110.0 ± 10.1 months in CONUT ≥5 and 121.4 ± 7.2 months in CONUT ≤4 patients (p = .47). CONCLUSIONS: Preoperative CONUT score may be an independent predictor of early serious infection after kidney transplantation. It may also be related to BPAR, which develops within 6 months. The CONUT score may serve as a simple and practical tool for infection and BPAR risk stratification in routine clinical practice.