Albumin-bilirubin grade as a prognostic factor of hepatocellular carcinoma after treatment with orthotopic liver transplantation

Background: Hepatic function restoration is the main process taking place after liver transplantation. Albumin-bilirubin (ALBI) grade is a new tool for assessing the severity of liver dysfunction. This evidence-based model is solely based on serum bilirubin and albumin levels, which could help clinicians obtain a more objective scale that guides disease diagnosis and treatment.

Methods: Total bilirubin levels, albumin amounts, and other biochemical indicators were determined in a total of 75 adult patients who underwent orthotopic liver transplantation (OLT) for HCC. The aim of the present study was to assess the prognostic value of the ALBI grade in patients with hepatocellular carcinoma (HCC).

Results: Median total bilirubin at the time of transplantation was 18.20 µmol/L (range, 12.50-43.63), while median albumin was 40.10 g/L (range, 35.21-44.17). Among the assessed patients, 27 (36.0%) experienced HCC recurrence after OLT and 23 (30.7%) died during follow-up. Patients with ALBI grade 1 had a survival advantage over those of other grades. ALBI grade 1 predicted the better post-operative overall survival (OS) and recurrence-free survival (RFS) in HCC patients after OLT [HR =3.095 (1.290-7.426), P=0.011; HR =3.967 (1.640-9.597), P=0.002, respectively]. In multivariate logistic regression analysis, ALBI grade (grade 1 vs. grades 2 and 3) was a significant independent prognostic factor of HCC recurrence after OLT [OR =6.842 (1.550-30.199), P=0.011].

Conclusions: Our findings indicated that ALBI grade is a potential predictor of both OS and RFS, representing an independent prognostic marker of HCC following OLT, improving the preoperative liver function status may promote the prognosis of patients with HCC after OLT.