Albumin-Bilirubin Score for Predicting Post-Transplant Complications Following Adult-to-Adult Living Donor Liver Transplantation

Abstract

BackgroundAlbumin-Bilirubin (ALBI) grade has been evaluated as an objective method to assess liver function and predict postoperative complications, particularly after hepatectomy in patients with hepatocellular carcinoma (HCC). However, ALBI grade was rarely used in evaluation in living donor liver transplantation (LDLT).Material/MethodsBetween March 2005 and November 2015, 272 consecutive patients undergoing right-lobe LDLT were enrolled in this study. According to the ALBI score used to evaluate recipients preoperatively, those patients were divided into 3 grades (I, II, and III). Demographic findings and the post-operative complication rates were collected and compared among groups.ResultsThe proportions of massive blood cell transfusions were different among those 3 grades (p<0.05). The patients in grade III had a higher risk of bacterial pneumonia and early allograft dysfunction (EAD) compared to grade I (p=0.029 and p=0.038, respectively) and grade II (p=0.006 and p=0.007, respectively). The area under the receiver operating characteristic curve of ALBI, Child-Pugh, and MELD for predicting 30-day mortality were 0.702 (95% CI: 0.644–0.756), 0.669 (95% CI: 0.580–0.697, p=0.510, versus ALBI grade), and 0.540 (95% CI: 0.580–0.697, p=0.144, versus ALBI grade), respectively.ConclusionsALBI grade was a good index for predicting post-operative complications and had a predictive ability similar to those of the Child-Pugh classification and MELD score.

The role of preoperative albumin‐bilirubin grade for oncological risk stratification in liver transplant patients with hepatocellular carcinoma

“…A higher surgical risk profile could be an additional proinflammatory trigger of inferior oncological outcome in grade 3 patients. Comparable to a recently presented study by Zhang et al, we noticed a significant correlation between increased ALBI grade and surgical complications, such as bleeding (Figure A) and RBC transfusion requirements (Figure B), who are both suggested to induce tumor‐promoting immunomodulatory mechanisms . Indeed, early posttransplant peak serum levels of the proinflammatory markers CRP (Figure C) and IL‐6 (Figure D) were significantly higher in grade 3 compared with grade 1 or 2 patients of our study.…”

Upper gastrointestinal bleeding in Egyptian patients with cirrhosis: Post‐therapeutic outcome and prognostic indicators

“…Although ALBI score was introduced to assess the liver function in patients with HCC, yet different recent studies proved its usefulness in predicting complication and survival for patients with liver cirrhosis when complicated with acute liver failure, or acute UGIB . More recently, its use in the assessment of patients undergoing living donor transplantation was studied . ALBI score, compared with the traditional MELD and CP scores, is more simple, easy, and readily comparable.…”

“…30 More recently, its use in the assessment of patients undergoing living donor transplantation was studied. 31 ALBI score, compared with the traditional MELD and CP scores, is more simple, easy, and readily comparable. It does not depend on the subjective variables of the CP score, that is, ascites and hepatic encephalopathy, and it does not include a variable with great laboratory-to-laboratory variation like international normalized ratio.…”

Treatment of Hepatocellular Carcinoma-associated Portal Vein Tumor Thrombus Using Combination of Portal Vein Stent Insertion and Endovascular Lodine-125 Seed-strip Implantation Followed by Transcatheter Arterial Chemoembolization- Sorafenib

“…In all patients, HCC diagnosis was con rmed either via histology or by a combination of two imaging approaches and elevated α-fetoprotein, as per the American Association guidelines [17]. Magnetic resonance imaging (MRI) or computed tomography CT) was used to diagnose PVTT based on the presence of a low attenuation intraluminal mass that partially or fully occluded the portal vein or lled a portal vein defect [18].…”

“…The Common Terminology Criteria for Adverse Events (CTCAE) v4.0 assessment was used to gauge any complications associated with treatment [8]. Albumin-Bilirubin (ALBI) scores were used as an objective means of gauging liver function, with scores being calculated solely based upon albumin and bilirubin levels [ALBI score=log10 bilirubin (μmol/L) ×0.66) + (albumin (g/L) ×−0.0852)] [17]. The modi ed Response Evaluation Criteria in Solid Tumors (mRECIST) criteria for HCC were used to gauge tumor responses, with possible responses including complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD) (Fig.…”