الفهرس 
LIVER TRANSPLANTATION (LT)Only 14 pages are availabe for public view
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Abstract
L
iver transplantation is a life-saving therapeutic intervention that contributes to a better quality of life in patients with end-stage or acute liver failure.
Liver transplantation is a complex procedure that demands proper selection of candidate patient with good preoperative assessment and carful collection of donor to insure high quality of life to both of them.
Many prognostic scores have been proposed to predict the outcome of LT. the most commonly used systems are the Model for End-Stage Liver Disease (MELD) and Child-Pugh stage. The Albumin-Bilirubin (ALBI) grade was proposed to assess overall survival in patients with HCC undergoing hepatectomy, trans-arterial chemoembolization, and sorafenib treatment. In our study we tried to evaluate ALBI grade as predictor of post LT outcomes.
Our study was conducted on patients underwent LT at Liver Transplantation Unit, Cairo Fatemic Hospital (Cairo, Egypt) from April 2018 till December 2021 with follow up of enrolled patient for 6 months’ afterword. There were 112 patients underwent LT at the period of the study, 108 of them met the inclusion criteria and were enrolled in the study while 4 cases were excluded (pediatric cases). The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki, and was approved by Ain shams University Research Ethics Committee (REC).
This study showed male predominance among enrolled patients 71 cases (65.7%), with mean age of 48.09 ± 12.79 years’ old and mean BMI of 27.84 ± 5.99. The most commonly recorded indications of LT in our study were HCC, ESLD due to HCV or HBV, AIH and cryptogenic liver cirrhosis.
The present study showed that the median MELD score among enrolled patients was 15 and the median Child score was 9 while the median ALBI score was -1.51.
The overall incidence of post-operative complications was 43.5% (47 out of 108 cases) and the most frequent cause was biliary complications 20.4% of all cases.
The early mortality (during the 1st six months after surgery) was 19.4% (21 out of 108 mortality cases) and the most common cause of mortality was sepsis 28.6% then biliary complications 9.5%.
There was statistically significant relation between ALBI grade and mortality with high mortality rate in ALBI grade II and ALBI grade III (with P-value 0.024). There was no statistically significant relation between ALBI grade and complications or HCC recurrence.
The percentage of complicated cases in ALBI grade II + III group (44.9%) is higher than the percentage of complicated cases in ALBI grade I (30.0%) without reaching statistical significance. The percentage of Mortality cases in ALBI grade II + III group (21.4%) is higher than the percentage of complicated cases in ALBI grade I (0%) without reaching statistical significance.
There was statistically significant decrease in the mean overall survival (months) in patients with MELD score ≥16, ALBI grade III, patients with post-operative infection, patients with biliary complications, patients with pulmonary embolism, patients with acute kidney injury and complicated patients(in general) than other patients with p-value = 0.001, 0.028, <0.001, 0.029, <0.001, <0.001 and 0.001; respectively while no statistically significant relation found between overall survival of the studied patients and the other studied parameters.