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

Background: Liver transplantation (LT) is the only treatment option that increases survival in end-stage hepatocellular carcinoma (HCC) patients. Determining prognosis is important for the management and treatment planning of patients with HCC. Objectives: The present study aimed to evaluate the performance of the Albumin-Bilirubin Index (ALBI) in predicting overall survival (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. Patients with LT for primary HCC were recruited consecutively in two independent medical centers between 2012 and 2023. Eligibility criteria and participant characteristics were determined as HCC patients with cirrhosis, extrahepatic disease, and no major vascular involvement. The OS and recurrence-free survival (RFS) were the primary outcomes of the study. The secondary outcomes were to analyze the recurrence rate and the clinical variables affecting it. Continuous variables are shown as mean or standard deviation. Categorical variables are shown as No. (%), while the same variables are compared using Fisher’s exact test or χ2 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 grade 2, 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 has some 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 reliable biomarker for predicting OS. Therefore, further studies are needed that include a combination of multiple risk factors to assess postoperative prognosis in liver transplant patients.