Preoperative Creatinine-to-Cystatin C Ratio and 1-year Risk of Infection-Related Hospitalization or Death with a Functioning Graft in Older Kidney Transplant Recipients.

Authors

Rongxin Chen, Lu Xu, Guanghui Li, Jiali Fang, Jialin Wu, Luhao Liu, Zheng Chen

Published in

Clinical interventions in aging. Volume 21. Pages 626251. Epub Sep 18, 2026.

Abstract

Older kidney transplant recipients experience substantial early infection-related morbidity. The unscaled preoperative creatinine-to-cystatin C ratio (hereafter SI) is routinely available and may serve as an indirect laboratory-derived vulnerability marker for sarcopenia. We evaluated associations of SI with 1-year infection-related hospitalization and death with a functioning graft (DWFG).
We analyzed 497 recipients aged ≥65 years transplanted in 2017-2023 in a single-center analysis of a prospectively maintained database. SI used the last paired sample before induction immunosuppression. The primary endpoint was time to first infection-related hospitalization or DWFG within 365 days; components were analyzed separately. Cox models used prespecified adjustment and exploratory interactions by sex and pretransplant dialysis modality. Incremental value was evaluated by bootstrap-corrected discrimination, calibration, and Brier score.
Median age was 68.1 years; the full cohort included 312 men (62.8%) and 185 women (37.2%), with median SI 0.82 (IQR 0.70-0.95). The composite endpoint occurred in 182/497 (36.6%), infection-related hospitalization in 165/497 (33.2%), and DWFG in 29/497 (5.8%). Lower SI was associated with the composite (adjusted HR 1.32 per 1 SD decrease, 95% CI 1.09-1.60; p=0.004), infection-related hospitalization (HR 1.28, 95% CI 1.05-1.57; p=0.015), and, with greater uncertainty, DWFG (HR 1.62, 95% CI 1.04-2.52; p=0.034). There was no evidence of interaction by sex (p=0.86) or dialysis modality (p=0.91). Adding SI changed Harrell's C-index from 0.609 to 0.625 (Δ0.016; 95% CI -0.008 to 0.039).
In the entire cohort, lower preoperative SI was associated with a higher 1-year risk of the composite endpoint, which was driven mainly by infection-related hospitalization. SI is not a standalone risk-stratification tool, and prospective multicenter external validation is required before clinical implementation.

PMID:
42775284
Bibliographic data and abstract were imported from PubMed on 23 Sep 2026.

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