Impact of neohepatic albumin-bilirubin scores on renal outcomes following living donor liver transplantation: a propensity score analysis.

Introduction and objectives: Acute kidney injury (AKI) after liver transplantation (LT) impacts patient and graft outcomes. The Albumin-Bilirubin (ALBI) score, an objective and sensitive liver function index, may help predict post-LT outcomes. This study evaluated the association between neohepatic ALBI scores and renal outcomes in living donor LT (LDLT) recipients.

Patients and methods: We examined 2171 adult LDLT recipients between 2012 and 2019. Outcomes included severe post-LT AKI, renal replacement therapy (RRT), chronic kidney disease (CKD) at 1 year, early allograft dysfunction (EAD), and overall graft failure. Multivariate logistic regression, Cox proportional hazards regression, and propensity score matched (PSM) analyses were performed to evaluate the association between neohepatic ALBI and post-LT outcomes.

Results: Severe AKI, RRT, CKD, EAD, and overall graft failure occurred in 21.6%, 2.2%, 41.9%, 5.9%, and 15.8% of patients, respectively. Higher neohepatic ALBI scores (≥-1.615) were significantly associated with severe AKI (OR: 2.34, 95% CI: 1.79-3.04, P<0.001, multivariate analysis; OR: 2.18, 95% CI: 1.62-2.95, P<0.001, PSM analysis), RRT (OR: 3.80, 95% CI: 1.53-11.31, P=0.008, multivariate analysis; OR: 7.17, 95% CI: 1.61-31.89, P=0.010, PSM analysis), CKD (OR: 1.22, 95% CI: 1.00-1.47, P=0.044, multivariate analysis; OR: 1.43, 95% CI: 1.11-1.85, P=0.006, PSM analysis), and overall graft failure (HR: 1.30, 95% CI: 1.01-1.68, P=0.041, multivariate analysis; HR: 1.55, 95% CI: 1.08-2.23, P=0.018, PSM analysis).

Conclusions: Neohepatic ALBI scores are significantly associated with post-LT severe AKI, RRT, CKD, and graft failure, underscoring their prognostic value in LDLT recipients.