Abstract
Background
Although MELD score is a reliable tool for estimating mortality in the waiting list, criteria for preoperative prediction of survival after liver transplantation (LT) are lacking. ALBI score was validated as a prognostic marker for hepatocellular carcinoma patients undergoing transarterial chemoembolization, hepatic resection, and sorafenib treatment but not for LT outcomes yet. This study aimed to evaluate ALBI score as a prognostic factor in LT.
Methods
This is a single-center analysis of patients undergoing LT between October 2001 and June 2017. Primary endpoint was overall post-LT mortality. Secondary endpoint was 90-day mortality.
Results
Of all 301 patients included in this study, 185 (61.5%) were males. The median age was 54.1 ± 11.3 years. Univariate and multivariate analysis revealed that ALBI grade 3 (HR 1.836, 95% CI 1.154–2.921, p = 0.010), low serum albumin (HR 0.628, 95% CI 0.441–0.893, p = 0.010), black race (HR 2.431, 95% CI 1.160–5.092, p = 0.019), and elevated body mass index (HR 1.061, 95% CI 1.022–1.102, p = 0.002) all were associated with decreased overall survival following LT. Patients with both ALBI grade 3 (n = 25) and calculated MELD score ≥ 25 had the lowest overall survival (p < 0.001).
Discussion
ALBI grade 3 was related to lower post-LT survival and can be utilized as a tool for risk stratification in LT.
Similar content being viewed by others
References
Chen HP, Tsai YF, Lin JR, Liu FC, Yu HP. Recipient age and mortality risk after liver transplantation: a population-based cohort study. PLoS ONE. 2016;11:e0152324.
Rana A, Ackah RL, Webb GJ, et al. No gains in long-term survival after liver transplantation over the past three decades. Ann Surg. 2019;269:20–27.
Alferink LJM, Oey RC, Hansen BE, et al. The impact of infections on delisting patients from the liver transplantation waiting list. Transpl Int. 2017;30:807–816.
Kalafateli M, Mantzoukis K, Choi Yau Y, et al. Malnutrition and sarcopenia predict post-liver transplantation outcomes independently of the Model for End-stage Liver Disease score. J Cachexia Sarcopenia Muscle. 2017;8:113–121.
Huo TI, Lin HC, Lee SD. Model for end-stage liver disease and organ allocation in liver transplantation: where are we and where should we go? J Chin Med Assoc. 2006;69:193–198.
Ling Q, Dai H, Zhuang R, et al. Predicting short-term survival after liver transplantation on eight score systems: a national report from China Liver Transplant Registry. Sci Rep. 2017;7:42253.
Klein KB, Stafinski TD, Menon D. Predicting survival after liver transplantation based on pre-transplant MELD score: a systematic review of the literature. PLoS ONE. 2013;8:e80661.
Mazurak VC, Tandon P, Montano-Loza AJ. Nutrition and the transplant candidate. Liver Transpl. 2017;23:1451–1464.
Oh IS, Sinn DH, Kang TW, et al. Liver function assessment using albumin–bilirubin grade for patients with very early-stage hepatocellular carcinoma treated with radiofrequency ablation. Dig Dis Sci. 2017;62:3235–3242. https://doi.org/10.1007/s10620-017-4775-8
Pinato DJ, Sharma R, Allara E, et al. The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol. 2017;66:338–346.
Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—the ALBI grade. J Clin Oncol. 2015;33:550–558.
Merion RM, Schaubel DE, Dykstra DM, et al. The survival benefit of liver transplantation. Am J Transpl. 2005;5:307–313.
Freeman RB. Model for end-stage liver disease (MELD) for liver allocation: a 5-year score card. Hepatology. 2008;47:1052–1057.
Onaca NN, Levy MF, Netto GJ, et al. Pretransplant MELD score as a predictor of outcome after liver transplantation for chronic hepatitis C. Am J Transpl. 2003;3:626–630.
Ioannou GN. Development and validation of a model predicting graft survival after liver transplantation. Liver Transpl. 2006;12:1594–1606.
Dutkowski P, Oberkofler CE, Slankamenac K, et al. Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era. Ann Surg. 2011;254:745–753.
Halldorson JB, Bakthavatsalam R, Fix O, Reyes JD, Perkins JD. D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient matching. Am J Transpl. 2009;9:318–326.
Hiraoka A, Kumada T, Kudo M, et al. Albumin–bilirubin (ALBI) grade as part of the evidence-based clinical practice guideline for HCC of the Japan Society of Hepatology: a comparison with the liver damage and Child–Pugh classifications. Liver Cancer. 2017;6:204–215.
Wang YY, Zhong JH, Su ZY, et al. Albumin–bilirubin versus Child–Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg. 2016;103:725–734.
Zou H, Wen Y, Yuan K, et al. Combining albumin–bilirubin score with future liver remnant predicts post-hepatectomy liver failure in HBV-associated HCC patients. Liver Int. 2018;38:494–502.
Andreatos N, Amini N, Gani F, et al. Albumin–bilirubin score: predicting short-term outcomes including bile leak and post-hepatectomy liver failure following hepatic resection. J Gastrointest Surg. 2017;21:238–248.
Shao L, Han B, An S, et al. Albumin-to-bilirubin score for assessing the in-hospital death in cirrhosis. Transl Gastroenterol Hepatol. 2017;2:88.
Kanda M, Tanaka C, Kobayashi D, et al. Preoperative albumin–bilirubin grade predicts recurrences after radical gastrectomy in patients with pT2-4 gastric cancer. World J Surg. 2017;42:773–781.
Ronald J, Wang Q, Choi SS, et al. Albumin–bilirubin grade versus MELD score for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. Diagn Interv Imaging. 2018;99:163–168.
Hickey R, Mouli S, Kulik L, et al. Independent analysis of albumin–bilirubin grade in a 765-patient cohort treated with transarterial locoregional therapy for hepatocellular carcinoma. J Vasc Interv Radiol. 2016;27:795–802.
Chedid MF, Picon RV, Chedid AD. ALBI and PALBI: novel scores for outcome prediction of cirrhotic outpatients awaiting liver transplantation. Ann Hepatol. 2018;17:906–907.
Chan AW, Kumada T, Toyoda H, et al. Integration of albumin–bilirubin (ALBI) score into Barcelona Clinic Liver Cancer (BCLC) system for hepatocellular carcinoma. J Gastroenterol Hepatol. 2016;31:1300–1306.
Cholankeril G, Wong RJ, Hu M, et al. Liver transplantation for nonalcoholic steatohepatitis in the US: temporal trends and outcomes. Dig Dis Sci. 2017;62:2915–2922.
Chedid MF. Nonalcoholic steatohepatitis: the second leading indication for liver transplantation in the USA. Dig Dis Sci. 2017;62:2621–2622. https://doi.org/10.1007/s10620-017-4724-6
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest.
Rights and permissions
About this article
Cite this article
Bernardi, N., Chedid, M.F., Grezzana-Filho, T.J.M. et al. Pre-transplant ALBI Grade 3 Is Associated with Increased Mortality After Liver Transplantation. Dig Dis Sci 64, 1695–1704 (2019). https://doi.org/10.1007/s10620-019-5456-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-019-5456-6