{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T14:09:47Z","timestamp":1789135787325,"version":"build-2803163510"},"reference-count":37,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007210","name":"RWTH Aachen University","doi-asserted-by":"publisher","award":["START-Program (#01\/23)"],"award-info":[{"award-number":["START-Program (#01\/23)"]}],"id":[{"id":"10.13039\/501100007210","id-type":"DOI","asserted-by":"publisher"}]},{"award":["START-Program (#01\/23)"],"award-info":[{"award-number":["START-Program (#01\/23)"]}],"id":[{"id":"https:\/\/ror.org\/04xfq0f34","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Recipient-related factors continue to influence long-term outcomes after deceased-donor liver transplantation (DDLT). This study evaluated the prognostic value of the preoperative C-reactive protein-to-albumin ratio (CAR) for recipient survival (RS) and graft survival (GS). Methods: Adult patients undergoing DDLT between 2010 and 2023 were retrospectively analyzed. Re-transplantations, split or domino transplants, patients who died within 90 days and patients with early allograft dysfunction were excluded. Primary endpoints were 3-year RS and GS. Receiver operating characteristic analysis was used to determine the optimal CAR cut-off. Survival was assessed using Kaplan\u2013Meier analysis and Cox regression. Results: A total of 330 patients were included. Mean RS and GS were 112 months (95%CI 106\u2013119) and 110 months (95%CI 103\u2013116), respectively. Preoperative CAR demonstrated the strongest predictive value for 3-year RS (AUC = 0.70, p &lt; 0.001) and GS (AUC = 0.71, p &lt; 0.001). A CAR cut-off of 41% provided optimal discrimination. Patients with CAR &gt; 41% had significantly reduced 3-year RS (31 vs. 34 months, p &lt; 0.001) and GS (30 vs. 34 months, p &lt; 0.001). CAR &gt; 41% was independently associated with increased risk of 3-year mortality (HR 2.101, 95%CI 1.277\u20133.456, p = 0.003) and graft loss (HR 3.666, 95%CI 1.804\u20137.449, p &lt; 0.001). Similar results were observed for 5-year outcomes. Conclusions: Elevated preoperative CAR is independently associated with inferior patient and graft survival and may enhance risk stratification after DDLT.<\/jats:p>","DOI":"10.3390\/jcm15187063","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:29:29Z","timestamp":1789133369000},"page":"7063","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative C-Reactive Protein-to-Albumin Ratio Predicts Recipient and Graft Survival After Deceased-Donor Liver Transplantation"],"prefix":"10.3390","volume":"15","author":[{"given":"David","family":"Erren","sequence":"first","affiliation":[{"name":"Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9624-6042","authenticated-orcid":false,"given":"Franziska A.","family":"Meister","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsten","family":"Gro\u00dfe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, University Hospital RWTH, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5576-6914","authenticated-orcid":false,"given":"Tony","family":"Bruns","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, University Hospital RWTH, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Gestels","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Beetz","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Oldhafer","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin W.","family":"von Websky","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Vogel","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian W. R.","family":"Vondran","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5138-4214","authenticated-orcid":false,"given":"Iakovos","family":"Amygdalos","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstra\u00dfe 30, 52074 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1111\/j.1600-6143.2008.02400.x","article-title":"Survival outcomes following liver transplantation (SOFT) score: A novel method to predict patient survival following liver transplantation","volume":"8","author":"Rana","year":"2008","journal-title":"Am. 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