Value of pretransplant albumin-bilirubin score in predicting outcomes after liver transplantation
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摘要
BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver transplantation. The albuminbilirubin(ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.AIM To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.METHODS The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.RESULTS The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30(interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%.The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for ALBI scores to predict postoperative survival was-1.48. Patients with an ALBI score >-1.48 had a significantly lower survival rate than those with an ALBI score ≤-1.48(73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications,a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation(P < 0.05 for all).CONCLUSION The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.
BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver transplantation. The albuminbilirubin(ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.AIM To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.METHODS The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.RESULTS The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30(interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%.The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for ALBI scores to predict postoperative survival was-1.48. Patients with an ALBI score >-1.48 had a significantly lower survival rate than those with an ALBI score ≤-1.48(73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications,a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation(P < 0.05 for all).CONCLUSION The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.
BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver transplantation. The albuminbilirubin(ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.AIM To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.METHODS The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.RESULTS The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30(interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%.The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for ALBI scores to predict postoperative survival was-1.48. Patients with an ALBI score >-1.48 had a significantly lower survival rate than those with an ALBI score ≤-1.48(73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications,a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation(P < 0.05 for all).CONCLUSION The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.
引文
1 Xu SL,Zhang YC,Wang GY,Yang Q,Liu B,Zhang J,Li H,Wang GS,Yang Y,Chen GH.Survival analysis of sirolimus-based immunosuppression in liver transplantation in patients with hepatocellular carcinoma.Clin Res Hepatol Gastroenterol 2016;40:674-681[PMID:27825633 DOI:10.1016/j.clinre.2016.03.006]
2 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[PMID:24349010 DOI:10.1371/journal.pone.0080661]
3 Han S,Kwon JH,Jung SH,Seo JY,Jo YJ,Jang JS,Yeon SM,Jung SH,Ko JS,Gwak MS,Cho D,Son HJ,Kim GS.Perioperative Fresh Red Blood Cell Transfusion May Negatively Affect Recipient Survival After Liver Transplantation.Ann Surg 2018;267:346-351[PMID:27805962 DOI:10.1097/SLA.0000000000002062]
4 Otto G.Liver transplantation:an appraisal of the present situation.Dig Dis 2013;31:164-169[PMID:23797139 DOI:10.1159/000347213]
5 Dolgin NH.Health Care Rich,Resource Poor:Struggling with the National Shortage of Organs in Liver Transplantation.AMA J Ethics 2016;18:97-100[PMID:27326433]
6 Johnson PJ,Berhane S,Kagebayashi C,Satomura S,Teng M,Reeves HL,O'Beirne J,Fox R,Skowronska A,Palmer D,Yeo W,Mo F,Lai P,I?arrairaegui M,Chan SL,Sangro B,Miksad R,Tada T,Kumada T,Toyoda H.Assessment of liver function in patients with hepatocellular carcinoma:a new evidence-based approach-the ALBI grade.J Clin Oncol 2015;33:550-558[PMID:25512453 DOI:10.1200/JCO.2014.57.9151]
7 Andreatos N,Amini N,Gani F,Margonis GA,Sasaki K,Thompson VM,Bentrem DJ,Hall BL,Pitt HA,Wilson A,Pawlik TM.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[PMID:27619809 DOI:10.1007/s11605-016-3246-4]
8 Zou D,Qi X,Zhu C,Ning Z,Hou F,Zhao J,Peng Y,Li J,Deng H,Guo X.Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis:Aretrospective study.Turk J Gastroenterol 2016;27:180-186[PMID:27015623 DOI:10.5152/tjg.2016.15502]
9 Clavien PA,Barkun J,de Oliveira ML,Vauthey JN,Dindo D,Schulick RD,de Santiba?es E,Pekolj J,Slankamenac K,Bassi C,Graf R,Vonlanthen R,Padbury R,Cameron JL,Makuuchi M.The ClavienDindo classification of surgical complications:five-year experience.Ann Surg 2009;250:187-196[PMID:19638912 DOI:10.1097/SLA.0b013e3181b13ca2]
10 Chan AW,Chong CC,Mo FK,Wong J,Yeo W,Johnson PJ,Yu S,Lai PB,Chan AT,To KF,Chan SL.Applicability of albumin-bilirubin-based Japan integrated staging score in hepatitis B-associated hepatocellular carcinoma.J Gastroenterol Hepatol 2016;31:1766-1772[PMID:26992142 DOI:10.1111/jgh.13339]
11 Toyoda H,Lai PB,O'Beirne J,Chong CC,Berhane S,Reeves H,Manas D,Fox RP,Yeo W,Mo F,Chan AW,Tada T,I?arrairaegui M,Vogel A,Schweitzer N,Chan SL,Sangro B,Kumada T,Johnson PJ.Longterm impact of liver function on curative therapy for hepatocellular carcinoma:application of the ALBIgrade.Br J Cancer 2016;114:744-750[PMID:27022825 DOI:10.1038/bjc.2016.33]
12 Rauchfuss F,Zidan A,Scheuerlein H,Dittmar Y,Bauschke A,Settmacher U.Waiting time,not donorrisk-index,is a major determinant for beneficial outcome after liver transplantation in high-MELDpatients.Ann Transplant 2013;18:243-247[PMID:23792527 DOI:10.12659/AOT.883924]
13 Strassburg CP.[Patient selection and indications for liver transplantation].Chirurg 2013;84:363-371[PMID:23576124 DOI:10.1007/s00104-012-2418-3]
14 Kim WR,Biggins SW,Kremers WK,Wiesner RH,Kamath PS,Benson JT,Edwards E,Therneau TM.Hyponatremia and mortality among patients on the liver-transplant waiting list.N Engl J Med 2008;359:1018-1026[PMID:18768945 DOI:10.1056/NEJMoa0801209]
15 Huang HC,Lee FY,Huo TI.Major adverse events,pretransplant assessment and outcome prediction.JGastroenterol Hepatol 2009;24:1716-1724[PMID:20136958 DOI:10.1111/j.1440-1746.2009.06025.x]
16 Marroni CP,de Mello Brand?o AB,Hennigen AW,Marroni C,Zanotelli ML,Cantisani G,Fuchs SC;Liver Transplantation Group.MELD scores with incorporation of serum sodium and death prediction in cirrhotic patients on the waiting list for liver transplantation:a single center experience in southern Brazil.Clin Transplant 2012;26:E395-E401[PMID:22882694 DOI:10.1111/j.1399-0012.2012.01688.x]
17 Bernardi M,Gitto S,Biselli M.The MELD score in patients awaiting liver transplant:strengths and weaknesses.J Hepatol 2011;54:1297-1306[PMID:21145851 DOI:10.1016/j.jhep.2010.11.008]
18 Durand F,Valla D.Assessment of prognosis of cirrhosis.Semin Liver Dis 2008;28:110-122[PMID:18293281 DOI:10.1055/s-2008-1040325]
19 Ge PL,Du SD,Mao YL.Advances in preoperative assessment of liver function.Hepatobiliary Pancreat Dis Int 2014;13:361-370[PMID:25100120]
20 Rahimi-Dehkordi N,Nourijelyani K,Nasiri-Tousi M,Ghodssi-Ghassemabadi R,Azmoudeh-Ardalan F,Nedjat S.Model for End stage Liver Disease(MELD)and Child-Turcotte-Pugh(CTP)scores:Ability to predict mortality and removal from liver transplantation waiting list due to poor medical conditions.Arch Iran Med 2014;17:118-121[PMID:24527973]
21 Fahrner R,Dondorf F,Ardelt M,Dittmar Y,Settmacher U,Rauchfu?F.Liver transplantation for hepatocellular carcinoma-factors influencing outcome and disease-free survival.World J Gastroenterol2015;21:12071-12082[PMID:26576092 DOI:10.3748/wjg.v21.i42.12071]
22 Neuberger J.An update on liver transplantation:A critical review.J Autoimmun 2016;66:51-59[PMID:26350881 DOI:10.1016/j.jaut.2015.08.021]
2 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[PMID:24349010 DOI:10.1371/journal.pone.0080661]
3 Han S,Kwon JH,Jung SH,Seo JY,Jo YJ,Jang JS,Yeon SM,Jung SH,Ko JS,Gwak MS,Cho D,Son HJ,Kim GS.Perioperative Fresh Red Blood Cell Transfusion May Negatively Affect Recipient Survival After Liver Transplantation.Ann Surg 2018;267:346-351[PMID:27805962 DOI:10.1097/SLA.0000000000002062]
4 Otto G.Liver transplantation:an appraisal of the present situation.Dig Dis 2013;31:164-169[PMID:23797139 DOI:10.1159/000347213]
5 Dolgin NH.Health Care Rich,Resource Poor:Struggling with the National Shortage of Organs in Liver Transplantation.AMA J Ethics 2016;18:97-100[PMID:27326433]
6 Johnson PJ,Berhane S,Kagebayashi C,Satomura S,Teng M,Reeves HL,O'Beirne J,Fox R,Skowronska A,Palmer D,Yeo W,Mo F,Lai P,I?arrairaegui M,Chan SL,Sangro B,Miksad R,Tada T,Kumada T,Toyoda H.Assessment of liver function in patients with hepatocellular carcinoma:a new evidence-based approach-the ALBI grade.J Clin Oncol 2015;33:550-558[PMID:25512453 DOI:10.1200/JCO.2014.57.9151]
7 Andreatos N,Amini N,Gani F,Margonis GA,Sasaki K,Thompson VM,Bentrem DJ,Hall BL,Pitt HA,Wilson A,Pawlik TM.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[PMID:27619809 DOI:10.1007/s11605-016-3246-4]
8 Zou D,Qi X,Zhu C,Ning Z,Hou F,Zhao J,Peng Y,Li J,Deng H,Guo X.Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis:Aretrospective study.Turk J Gastroenterol 2016;27:180-186[PMID:27015623 DOI:10.5152/tjg.2016.15502]
9 Clavien PA,Barkun J,de Oliveira ML,Vauthey JN,Dindo D,Schulick RD,de Santiba?es E,Pekolj J,Slankamenac K,Bassi C,Graf R,Vonlanthen R,Padbury R,Cameron JL,Makuuchi M.The ClavienDindo classification of surgical complications:five-year experience.Ann Surg 2009;250:187-196[PMID:19638912 DOI:10.1097/SLA.0b013e3181b13ca2]
10 Chan AW,Chong CC,Mo FK,Wong J,Yeo W,Johnson PJ,Yu S,Lai PB,Chan AT,To KF,Chan SL.Applicability of albumin-bilirubin-based Japan integrated staging score in hepatitis B-associated hepatocellular carcinoma.J Gastroenterol Hepatol 2016;31:1766-1772[PMID:26992142 DOI:10.1111/jgh.13339]
11 Toyoda H,Lai PB,O'Beirne J,Chong CC,Berhane S,Reeves H,Manas D,Fox RP,Yeo W,Mo F,Chan AW,Tada T,I?arrairaegui M,Vogel A,Schweitzer N,Chan SL,Sangro B,Kumada T,Johnson PJ.Longterm impact of liver function on curative therapy for hepatocellular carcinoma:application of the ALBIgrade.Br J Cancer 2016;114:744-750[PMID:27022825 DOI:10.1038/bjc.2016.33]
12 Rauchfuss F,Zidan A,Scheuerlein H,Dittmar Y,Bauschke A,Settmacher U.Waiting time,not donorrisk-index,is a major determinant for beneficial outcome after liver transplantation in high-MELDpatients.Ann Transplant 2013;18:243-247[PMID:23792527 DOI:10.12659/AOT.883924]
13 Strassburg CP.[Patient selection and indications for liver transplantation].Chirurg 2013;84:363-371[PMID:23576124 DOI:10.1007/s00104-012-2418-3]
14 Kim WR,Biggins SW,Kremers WK,Wiesner RH,Kamath PS,Benson JT,Edwards E,Therneau TM.Hyponatremia and mortality among patients on the liver-transplant waiting list.N Engl J Med 2008;359:1018-1026[PMID:18768945 DOI:10.1056/NEJMoa0801209]
15 Huang HC,Lee FY,Huo TI.Major adverse events,pretransplant assessment and outcome prediction.JGastroenterol Hepatol 2009;24:1716-1724[PMID:20136958 DOI:10.1111/j.1440-1746.2009.06025.x]
16 Marroni CP,de Mello Brand?o AB,Hennigen AW,Marroni C,Zanotelli ML,Cantisani G,Fuchs SC;Liver Transplantation Group.MELD scores with incorporation of serum sodium and death prediction in cirrhotic patients on the waiting list for liver transplantation:a single center experience in southern Brazil.Clin Transplant 2012;26:E395-E401[PMID:22882694 DOI:10.1111/j.1399-0012.2012.01688.x]
17 Bernardi M,Gitto S,Biselli M.The MELD score in patients awaiting liver transplant:strengths and weaknesses.J Hepatol 2011;54:1297-1306[PMID:21145851 DOI:10.1016/j.jhep.2010.11.008]
18 Durand F,Valla D.Assessment of prognosis of cirrhosis.Semin Liver Dis 2008;28:110-122[PMID:18293281 DOI:10.1055/s-2008-1040325]
19 Ge PL,Du SD,Mao YL.Advances in preoperative assessment of liver function.Hepatobiliary Pancreat Dis Int 2014;13:361-370[PMID:25100120]
20 Rahimi-Dehkordi N,Nourijelyani K,Nasiri-Tousi M,Ghodssi-Ghassemabadi R,Azmoudeh-Ardalan F,Nedjat S.Model for End stage Liver Disease(MELD)and Child-Turcotte-Pugh(CTP)scores:Ability to predict mortality and removal from liver transplantation waiting list due to poor medical conditions.Arch Iran Med 2014;17:118-121[PMID:24527973]
21 Fahrner R,Dondorf F,Ardelt M,Dittmar Y,Settmacher U,Rauchfu?F.Liver transplantation for hepatocellular carcinoma-factors influencing outcome and disease-free survival.World J Gastroenterol2015;21:12071-12082[PMID:26576092 DOI:10.3748/wjg.v21.i42.12071]
22 Neuberger J.An update on liver transplantation:A critical review.J Autoimmun 2016;66:51-59[PMID:26350881 DOI:10.1016/j.jaut.2015.08.021]