Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2019; 25(15): 1879-1889
Published online Apr 21, 2019. doi: 10.3748/wjg.v25.i15.1879
Value of pretransplant albumin-bilirubin score in predicting outcomes after liver transplantation
Tao Ma, Qing-Shan Li, Yue Wang, Bo Wang, Zheng Wu, Yi Lv, Rong-Qian Wu
Tao Ma, Qing-Shan Li, Yue Wang, Yi Lv, Rong-Qian Wu, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Tao Ma, Qing-Shan Li, Yue Wang, Bo Wang, Zheng Wu, Yi Lv, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: All authors helped perform the research; Ma T wrote the manuscript, designed and performed the procedures, and analysed the data; Li QS wrote the manuscript, drafted the conception, performed the experiments, and analysed the data; Wang Y contributed to writing the manuscript, and drafted the conception and design; Wang B and Wu Z contributed to writing the manuscript and performed the experiments; and Lv Y and Wu RQ contributed to writing the manuscript, and drafting the conception and design. All authors read and approved the final manuscript.
Supported by the Ministry of Education Innovation Team Development Program of China, No. IRT16R57; the National Natural Science Foundation of China, No. 81470896; and Research Fund for the Young Talent Recruiting Plans of Xi’an Jiaotong University (RW).
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (Permit Number: XJTU1AF2015LSL-057).
Informed consent statement: Written informed consent from the patients was waived due to the retrospective nature of this study.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rong-Qian Wu, MD, PhD, Professor, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 76, West Yanta Road, Xi’an 710061, Shaanxi Province, China. rwu001@mail.xjtu.edu.cn
Telephone: +86-29-85323204 Fax: +86-29-85252580
Received: February 18, 2019
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.