{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:18:48Z","timestamp":1783426728342,"version":"3.54.6"},"reference-count":34,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Nutritional status is an important determinant of outcomes after kidney transplantation, yet the prognostic significance of longitudinal changes in nutritional indices remains insufficiently investigated. We evaluated whether first-year changes in the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score were associated with long-term adverse outcomes in kidney transplant recipients (KTRs). Methods: This retrospective cohort study included 352 adult KTRs with a median follow-up of 11.4 years. PNI and CONUT were calculated before transplantation and at the first post-transplant year. Patients were categorized according to changes in nutritional status as improved\/stable or worsened. The primary outcome was a composite of end-stage renal disease (ESRD) or death with a functioning graft. Two separate multivariable logistic regression models were constructed to evaluate the associations of changes in first-year PNI and CONUT with the composite outcome after adjustment for clinically relevant demographic and transplant-specific variables, including first-year rejection episodes, estimated glomerular filtration rate (eGFR), and urine protein-to-creatinine ratio (PCR). Additional analyses were performed separately for graft loss and death with a functioning graft. Results: Baseline PNI and CONUT scores were comparable between patients with and without adverse outcomes. Patients who reached the composite outcome had significantly lower first-year eGFR (p = 0.001), whereas first-year rejection episodes and urine PCR were similar between the groups. After multivariable adjustment, worsening first-year PNI (OR: 2.02, 95% CI: 1.08\u20133.77, p = 0.028) and worsening first-year CONUT (OR: 2.01, 95% CI: 1.11\u20133.65, p = 0.022) remained independently associated with the composite outcome. Higher first-year eGFR was independently associated with a lower risk of adverse outcomes. Separate analyses of graft loss and death with a functioning graft supported the primary findings, with stronger associations observed for graft-related outcomes. Conclusions: Early deterioration in nutritional status, reflected by worsening changes in PNI and CONUT during the first post-transplant year, was independently associated with adverse long-term outcomes in KTRs. Serial assessment of these simple and inexpensive nutritional indices may improve long-term risk stratification and help identify patients who could benefit from closer clinical follow-up and individualized nutritional assessment.<\/jats:p>","DOI":"10.3390\/jcm15135299","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T09:53:46Z","timestamp":1783418026000},"page":"5299","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Post-Transplant Changes in Nutritional Status Predict Long-Term Graft Loss and Mortality"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2125-5881","authenticated-orcid":false,"given":"Taha Enes","family":"Cetin","sequence":"first","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, Gazi University, 06560 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer Faruk","family":"Akcay","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, Gazi University, 06560 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2123-5207","authenticated-orcid":false,"given":"Veysel Baran","family":"Tomar","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, Gazi University, 06560 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5041-1234","authenticated-orcid":false,"given":"Serhat","family":"Haliloglu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Gazi University, 06560 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7515-0501","authenticated-orcid":false,"given":"Anil Oguzhan","family":"Soylu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Gazi University, 06560 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadriye","family":"Altok","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, Gazi University, 06560 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasemin","family":"Erten","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, Gazi University, 06560 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1056\/NEJMra1700312","article-title":"Nutritional Management of Chronic Kidney Disease","volume":"377","author":"Fouque","year":"2017","journal-title":"N. 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