Published online Apr 21, 2019. doi: 10.3748/wjg.v25.i15.1879
Peer-review started: February 19, 2019
First decision: February 26, 2019
Revised: March 4, 2019
Accepted: March 16, 2019
Article in press: March 16, 2019
Published online: April 21, 2019
The albumin-bilirubin (ALBI) score, as a simple assessment of liver function, is objectively calculated by only two variables (albumin and bilirubin). It was proposed as a new method for preoperative risk evaluation to discern patients with the risk of adverse outcomes after hepatectomy. However, its ability to predict outcomes after liver transplantation has not been evaluated. Because of the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from LT.
The main topic of this study was to provide a potential scoring system for the allocation of donor liver resources by investigating the relationship between pretransplant ALBI score and outcomes after liver transplantation.
To retrospectively investigate the value of pretransplant ALBI scores in predicting outcomes after liver transplantation and as a tool for risk-stratifying patients on the liver transplant waiting list.
The research data were obtained from a computerized clinical database from the First Affiliated Hospital of Xi’an Jiaotong University and included 258 consecutive patients who received donation after cardiac death (DCD) and underwent liver transplantation from March 2012 to March 2017. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The performance of the ALBI score in predicting outcomes, including postoperative complications and survival analysis, was measured and evaluated.
This study analysed data from 258 patients. Thirty-five patients died during follow-up [17.30 (interquartile range: 8.90-28.98) mo], with an overall survival rate of 81.0%. The optimal cut-off value of preoperative ALBI scores to predict postoperative survival was -1.48. Patients with an ALBI score > -1.48 had a significantly lower survival rate than those with an ALBI score ≤ -1.48 (73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease (MELD) score ≥ 10 and < 10 and different Child-Pugh grades. Moreover, a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation (P < 0.05 for all). Of course, this study only initially confirmed the predictive value of the ALBI score for liver transplantation outcomes. The predictive value of multi-centre data resources and other donations, except after DCD, need to be further researched and confirmed.
After the ALBI grading system was developed to identify patients at risk for adverse outcomes after hepatectomy, this study hypothesized that this score may also be valuable in evaluating outcomes after liver transplantation. The ALBI score predicted overall survival and postoperative complications after liver transplantation. These data suggest that ALBI may be superior to MELD in risk-stratifying liver transplantation patients. In addition, ALBI may be a more readily applicable tool for modelling risk among patients undergoing liver transplantation because it relies on fewer variables.
The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list. Multi-centre and prospective studies are needed to confirm our findings.