Pre-transplant Albumin-Bilirubin Score as a Predictor of Post-transplant Survival and Prognosis Following Liver Transplantation for Hepatocellular Carcinoma

Abstract

Background: Liver transplantation (LT) is the only treatment option that increases survival in end-stage hepatocellularcarcinoma (HCC) patients. Determining prognosis is important for the management and treatment planning of patients withHCC. Objectives: The present study aimed to evaluate the performance of the Albumin-Bilirubin Index (ALBI) in predicting overallsurvival (OS) and recurrence risk in HCC patients undergoing LT. Methods: Two hundred primary HCC patients who underwent LT were included in the retrospective cohort study. Patientswith LT for primary HCC were recruited consecutively in two independent medical centers between 2012 and 2023. Eligibilitycriteria and participant characteristics were determined as HCC patients with cirrhosis, extrahepatic disease, and no majorvascular involvement. The OS and recurrence-free survival (RFS) were the primary outcomes of the study. The secondaryoutcomes were to analyze the recurrence rate and the clinical variables affecting it. Continuous variables are shown as mean orstandard deviation. Categorical variables are shown as No. (%), while the same variables are compared using Fisher's exact test or chi 2 test. Results: The one-, three-, and five-year OS rates were 92.0%, 82.8%, and 69.0% in ALBI grade 1, 87.2%, 76.8%, and 73.9% in ALBI grade2, and 86.1%, 84.7%, and 77.4% in ALBI grade 3. There was no significant difference in long-term OS between the groups. The one-,three-, and five-year RFS rates were 91.1%, 81.1%, and 73.0% in ALBI grade 1, 91.5%, 81.9%, and 81.9% in ALBI grade 2, and 90.0%, 84.0%,and 84.0% in ALBI grade 3. Likewise, long-term RFS outcomes were not significantly different between the groups. Our study hassome limitations. Due to its retrospective nature, it was difficult to avoid selection bias. Conclusions: The ALBI grade is not an independent prognostic factor for HCC patients undergoing LT and is not a reliablebiomarker for predicting OS. Therefore, further studies are needed that include a combination of multiple risk factors to assesspostoperative prognosis in liver transplant patients