The C-reactive protein-to-albumin ratio predicts one-year mortality in living donor kidney transplantation

Aim: The aim of this study was is to evaluate the effectiveness of the preoperative CRP/albumin ratio on first year mortality after living donor kidney transplantation. 
Material and Method: This retrospective single-center study includes a total of living kidney transplant recipients’ data who were transplanted between 2011-2020 years. Thirty-six patients who died within the first year after kidney transplantation among 2143 living kidney transplant recipients were included in the study group. Patients who have similar comobordities like mortality group patients who survives than one year after living donor kidney transplantation were enrolled as control group. 
Results: First year mortality was 1.67% (36/2143) in ten years. Patients in the mortality group were older than the control group (53±13 vs 43±12, p=0.002). The median time spent on dialysis in the mortality group was longer than in the control group (13 months vs 1 month, p=0.029). The median CRP/albumin ratio was higher in the mortality group (2.77 vs 0.85, p=0.001). CRP and CRP/albumin ratio were determined as independent factors affecting mortality in the first year after living donor kidney transplantation as a result of multivariate Cox regression analysis (HR=1.040;95% CI, 1.011-1.069; p=0.004 vs HR=1.148 95% CI, 1.044-1.262; p=0.007, respectively). ROC analysis showed that the CRP/albumin ratio had the power to predict one-year mortality (AUC 0.650 95% CI 0.513-0.787, p=0.041). Kaplan-Meier survival analysis showed a statistically significant difference between the two groups in terms of the cut-off value for CRP/albumin ratio (1.52). 
Conclusion: This study shows that the CRP/albumin ratio can be used to predict mortality in the first year after living donor kidney transplantation.