Combined preoperative MELD score and system immune-inflammation index predicts the prognosis of liver transplantation recipients: a single-centre retrospective cohort study
This single-centre retrospective study demonstrates that combining preoperative MELD scores with inflammatory markers, particularly the Systemic Immune-Inflammation Index (SII) and Neutrophil-to-Lymphocyte Ratio (NLR), significantly enhances the prediction of post-liver transplantation survival and identifies patients with a markedly elevated risk of mortality.
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For millions of people around the world, the liver is the body's silent, tireless worker, filtering toxins and managing energy. When this organ fails completely, the only path to survival is a transplant, a complex surgery that replaces the damaged organ with a healthy one from a donor. Decades of medical progress have made these surgeries safer and more successful, yet the journey does not end when the new organ is in place. Doctors still face a difficult challenge: predicting which patients will thrive and which will struggle after the operation. For years, the medical community has relied on a standard scoring system to measure how sick a patient is before the surgery. This system, known as the MELD score, looks at how well the liver and kidneys are working by measuring levels of specific chemicals in the blood. A higher score means the patient is sicker and needs a new liver sooner. However, this score only tells part of the story. It measures the failure of the organ itself but misses the state of the body's defense system. Just before a major surgery, a patient's immune system can be in a state of high alert or deep exhaustion, and this internal balance plays a massive role in how well they recover.
A team of researchers at the Second Affiliated Hospital of Chongqing Medical University decided to look closer at this missing piece of the puzzle. They wanted to see if combining the standard sickness score with a measure of the body's inflammation could give a clearer picture of a patient's future. Inflammation is the body's natural response to injury or infection, but when it is too high or out of control, it can make recovery harder. The researchers gathered data from 137 patients who had undergone liver transplants between late 2021 and early 2025. They did not just look at the standard liver scores; they also examined simple blood tests that reveal the ratio of different types of immune cells. Specifically, they focused on a calculation called the Systemic Immune-Inflammation Index, which combines the counts of three types of cells: platelets, which help blood clot; neutrophils, which fight infection; and lymphocytes, which manage the immune response. By looking at these numbers alongside the standard sickness score, the team hoped to find a way to spot patients who were at the highest risk of complications or death.
The study revealed that while the standard sickness score is important, it is not the whole story. The researchers found that patients with high levels of inflammation in their blood before surgery faced significantly worse outcomes, even if their liver sickness score was similar to others. When they looked at the patients who survived the longest, they saw a pattern: those who had both a high sickness score and high inflammation were the most vulnerable. In fact, the risk of death for patients who had both of these factors was nearly sixteen times higher than for patients who had neither. This suggests that a patient's body might be fighting a hidden battle before the surgery even begins. The inflammation acts like a second layer of risk, compounding the danger of the already damaged liver. The researchers also found that this combination of factors was a strong predictor of severe complications after the surgery, such as infections or the need for additional medical interventions.
What makes this discovery particularly useful is that the tools needed to find it are already available in almost every hospital. The blood tests used to calculate the inflammation score are routine and inexpensive, requiring no special equipment or complex procedures. The researchers determined specific cut-off points for these numbers, allowing doctors to identify high-risk patients before they even enter the operating room. For example, they found that a specific level of the inflammation index, around 349, marked a turning point where the risk of poor outcomes began to rise sharply. Similarly, they identified a sickness score of about 21 as a critical threshold. When a patient's numbers crossed both of these lines, the warning signal became very loud. This does not mean that surgery should be denied to these patients, but rather that it signals a need for extra care, closer monitoring, and perhaps more aggressive preparation to calm the body's inflammatory response before the operation.
The study was conducted at a single hospital and looked back at past records, which means the findings are a strong signal rather than a final proof. The researchers acknowledge that larger studies involving many hospitals would be needed to confirm these exact numbers and rules. However, the logic is sound: the liver is not the only organ that matters during a transplant. The body's overall state of readiness, measured by its immune cells, is just as critical. By paying attention to both the organ's failure and the body's inflammation, doctors can build a more complete map of the risks a patient faces. This approach offers a way to move beyond a single number and understand the complex reality of the human body before it undergoes one of its most demanding procedures. The goal is not just to replace a failing organ, but to ensure the rest of the body is strong enough to accept it.
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