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
Processing time: 58 Days and 22 Hours
Abstract
BACKGROUND

Due to 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 liver transplantation. The albumin-bilirubin (ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.

AIM

To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.

METHODS

The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.

RESULTS

The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30 (interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%. The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for 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 score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications, 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).

CONCLUSION

The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.

Keywords: Albumin-bilirubin score; Liver transplantation; Survival; Postoperative complications; Liver transplant waiting list

Core tip: The albumin-bilirubin (ALBI) grading system was developed to identify patients at risk for poor outcomes after hepatectomy. The study showed the preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for 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. A high ALBI score was also associated with an increased incidence of postoperative complications. Thus, the ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.