Value of pretransplant albumin-bilirubin score in predicting outcomes after liver transplantation

Table 1 Patient demographics (n = 258)

Patients characteristic	n (%)/mean ± SD/median (IQR)
Demographic feature
Age, yr	47.0 (39.0-56.0)
Male, n (%)	206 (79.8)
Coexisting condition
Smoking, n (%)	78 (30.2)
Drinking, n (%)	44 (17.1)
Hypertension, n (%)	19 (7.4)
Diabetes, n (%)	27 (10.5)
Etiology
Hepatocellular carcinoma, n (%)	87 (33.7)
Viral hepatitis, n (%)	200 (77.5)
Alcoholic cirrhosis, n (%)	8 (3.1)
PBC and AIH, n (%)	21 (8.2)
Other, n (%)	29 (11.2)
Clinical feature
ALBI score	-1.78 (-2.40 - -1.33)
MELD score	15.5 (11.0-23.0)
Child-Pugh grade
A, n (%)	43 (16.7)
B, n (%)	94 (36.4)
C, n (%)	121 (46.9)
Operation time (min)	390.0 (332.5-436.5)
Anhepatic phase (min)	49 (44-58)
Blood loss (mL)	1500 (900-3000)
Total input quantity (mL)	6040 (4810-7810)
Warm ischemia time (min)	9 (8-10)
Cold ischemia time (h)	5 (4-6)

Other etiologies included hepatolenticular degeneration, drug-induced liver injury, upper biliary tract obstruction, acute liver failure, and cryptogenic cirrhosis. SD: Standard deviation; IQR: Inter quartile range; PBC: Primary biliary cirrhosis; AIH: Autoimmune hepatitis; ALBI: Albumin-bilirubin; MELD; Model for end stage liver disease.

Table 2 Baseline comparison between patients with different albumin-bilirubin grades

Variable	ALBI ≤ -1.48 (n = 173)	ALBI > -1.48 (n = 85)	P-value
Demographic feature
Age (yr)	47 (39-55)	47 (38-56)	0.926
Male (Y/N)	138/35	68/17	0.965
Coexisting condition
Smoking (Y/N)	52/121	26/59	0.931
Drinking (Y/N)	26/147	18/67	0.217
Hypertension (Y/N)	13/160	6/79	0.895
Diabetes (Y/N)	15/158	12/73	0.179
Etiology			0.025
HCC (Y/N)	71/102	16/69	< 0.001
Viral hepatitis	143	57
Alcoholic cirrhosis	4	4
PBC and AIH	9	12
Other	17	12
Hepatic feature
MELD score	14 (10-18)	23 (17.5-28)	< 0.001
Child grade A/B/C	42/80/51	1/14/70	< 0.001
Preoperative laboratory value
RBC (1012/L)	3.40 (2.90-4.15)	2.94 (2.49-3.32)	< 0.001
HGB (g/L)	105.0 (88.0-130.0)	95.00 (86.5-107.0)	0.001
PLT (109/L)	59.0 (38.5-103.0)	45.0 (28.5-72.5)	0.002
WBC (109/L)	3.71 (2.55-5.36)	4.31 (2.84-7.38)	0.084
NEUT (109/L)	2.33 (1.67-3.74)	2.86 (1.80-5.90)	0.044
LYMPH (109/L)	0.70 (0.45-1.15)	0.60 (0.41-0.95)	0.189
MONO (109/L)	0.28 (0.18-0.45)	0.38 (0.22-0.57)	0.011
AFP (μg/L)	4.74 (2.73-16.30)	3.50 (2.22-6.23)	0.032
ALT (U/L)	32.00 (22.00-47.00)	38.00 (23.57-67.06)	0.042
AST (U/L)	41.50 (29.00-59.00)	54.52 (34.05-102.00)	0.001
TBIL (μmol/L)	32.75 (17.67-54.83)	105.48 (51.72-314.33)	< 0.001
DBIL (μmol/L)	11.70 (5.87-27.00)	50.70 (19.70-192.23)	< 0.001
ALB (g/L)	37.20 (34.50-41.99)	29.83 (26.95-32.11)	< 0.001
BUN (mmol/L)	4.39 (3.59-6.21)	5.07 (3.87-7.32)	0.077
CRE (μmol/L)	58.00 (48.00-68.85)	61.88 (48.15-82.00)	0.199
GLU (mmol/L)	5.60 (4.91-6.91)	6.06 (5.03-8.40)	0.062
PT (s)	17.20 (15.05-19.15)	20.70 (18.05-24.30)	< 0.001
APTT (s)	42.40 (39.15-47.70)	49.10 (43.25-54.75)	< 0.001
INR	1.41 (1.20-1.60)	1.74 (1.49-2.27)	< 0.001

ALBI: Albumin-bilirubin; MELD: Model for end stage liver disease; HCC: Hepatocellular carcinoma; PBC: Primary biliary cirrhosis; AIH: Autoimmune hepatitis; RBC: Red blood cells; HGB: Hemoglobin; PLT: Platelets; WBC: White blood cells; NEUT: Neutrophil granulocytes; LYMPH: Lymphocytes; MONO: Monocytes; AFP: Alpha-fetoprotein; ALT: Alanine aminotransferase; AST: Aspartate transaminase; TBIL: Total bilirubin; DBIL: Direct bilirubin; ALB: Albumin; BUN: Blood urea nitrogen; CRE: Creatinine; GLU: Glucose; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio.

Table 3 Univariate and multivariate logistic regression analysis of overall survival

Variable	Univariate		Multivariate
	P-value	OR (95%CI)	P-value	OR (95%CI)
ALBI grade	0.002	3.923 (1.495-5.716)	0.036	2.290 (1.057-4.963)
MELD grade	0.192	2.002 (0.706-5.676)
Child-Pugh grade
A	Reference
B	0.713	0.815 (0.273-2.431)
C	0.451	1.456 (0.548-3.868)
Age	0.537	1.010 (0.978-1.044)
Sex	0.233	0.629 (0.294-1.347)
Drinking	0.266	1.565 (0.711-3.447)
Smoking	0.931	0.968 (0.465-2.017)
Diabetes	0.791	0.852 (0.261-2.785)
Hypertension	0.576	1.402 (0.428-4.587)
HCC	0.972	1.013 (0.504-2.035)
Disease time	0.470	1.014 (0.977-1.051)
RBC	0.282	0.794 (0.522-1.208)
HGB	0.617	0.997 (0.987-1.008)
PLT	0.054	1.004 (1.000-1.008)	0.048	1.005 (1.000-1.011)
WBC	0.002	1.097 (1.034-1.165)	0.481	1.034 (0.942-1.134)
NEUT	0.494	1.010 (0.981-1.041)
LYMPH	0.615	1.071 (0.821-1.397)
MONO	0.457	1.106 (0.849-1.441)
AFP	0.085	1.000 (1.000-1.000)	0.391	1.000 (1.000-1.000)
ALT	0.002	1.001 (1.000-1.001)	0.278	1.000 (1.000-1.001)
AST	< 0.001	1.001 (1.001-1.002)	0.418	1.000 (0.999-1.002)
BUN	0.395	1.022 (0.972-1.075)
CRE	0.002	1.005 (1.002-1.008)	0.027	1.005 (1.001-1.026)
GLU	0.575	0.959 (0.830-1.109)
PT	0.181	1.034 (0.985-1.086)
INR	0.127	1.336 (0.921-1.937)
APTT	0.028	1.013 (1.001-1.024)	0.028	1.014 (1.001-1.026)
Operation time	0.007	1.005 (1.001-1.009)	0.182	1.003 (0.999-1.008)
Warm ischemia time	0.750	0.970 (0.803-1.171)
Cold ischemia time	0.145	1.192 (0.941-1.509)

OR: Odds ratio; CI: Confidence interval; ALBI: Albumin-bilirubin; MELD: Model for end stage liver disease; HCC: Hepatocellular carcinoma; RBC: Red blood cells; HGB: Hemoglobin; PLT: Platelets; WBC: White blood cells; NEUT: Neutrophil granulocytes; LYMPH: Lymphocytes; MONO: Monocytes; AFP: Alpha-fetoprotein; ALT: Alanine aminotransferase; AST: Aspartate transaminase; TBIL: Total bilirubin; DBIL: Direct bilirubin; ALB: Albumin; BUN: Blood urea nitrogen; CRE: Creatinine; GLU: Glucose; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio.

Table 4 Postoperative complications according to albumin-bilirubin grade

Complication	Low ALBI grade(n = 173)	High ALBI grade(n = 85)	P-value
Total complications (Y/N)	115/58	74/11	< 0.001
Pneumonia (Y/N)	51/122	33/52	0.132
AKI (Y/N)	79/94	57/28	0.001
Biliary complication (Y/N)	11/162	14/71	0.010
Porta vein thrombosis (Y/N)	3/170	0/85	0.546
Rejection (Y/N)	10/163	2/83	0.361
Intraabdominal bleeding (Y/N)	8/165	13/72	0.003
Coma for 24 h (Y/N)	1/172	4/81	0.075
Mechanical ventilation for 72 h (Y/N)	1/172	3/82	0.205
Septicemia (Y/N)	0/173	3/82	0.013
MOF (Y/N)	1/172	4/81	0.075
In-hospital mortality (Y/N)	3/170	4/81	0.330
SIRS (Y/N)	45/128	26/59	0.439
CCI, median (IQR)	29.60 (8.70-36.65)	36.20 (23.40-49.75)	< 0.001
Postoperative hospital stay, median days (IQR)	17.00 (13.50-24.00)	19.00 (12.50-25.00)	0.514

ALBI: Albumin-bilirubin; AKI: Acute kidney injury; MOF: Multiple organ failure; CCI: Comprehensive complication index; SIRS: Systemic inflammatory response syndrome; IQR: Interquartile range.