Impact of preoperative albumin-bilirubin grade on posttransplant hospitalization in adult liver transplant recipients

Abstract Background The albumin-bilirubin (ALBI) grade was initially developed as a prognostic tool for hepatocellular carcinoma and is increasingly recognized for assessing liver function and surgical risk. Objective To evaluate the relationship between preoperative ALBI grade and length of hospital and intensive care unit stay after deceased-donor liver transplantation (LT). Methods This retrospective study included 162 adult patients who underwent LT from brain-dead donors at our center between 2018 and 2023. Exclusion criteria were LT due to acute liver failure, re-transplantation, and simultaneous liver–kidney transplantation. ALBI grades (1, 2, 3) were calculated from pre-LT serum albumin and bilirubin levels. Demographic, intraoperative, and postoperative data—including hospital and intensive care unit lengths of stay and inhospital mortality—were analyzed. Results Among patients, 4 (2.5%) were ALBI-1, 70 (43.2%) ALBI-2, and 88 (54.3%) ALBI-3. ALBI grade 3 was significantly associated with longer hospital stay post-LT ( β = 7.420, 95% CI 2.407–12.434, p = 0.004) compared with lower grades. No significant association was found between ALBI grade and intensive care unit stay (grade 3: β = 0.432, p = 0.535; grade 2: β = −0.221, p = 0.723) compared with grade 1. Conclusion ALBI grade 3 predicts longer hospital stay but not ICU stay after LT, suggesting that the ALBI grade may serve as a useful predictor for posttransplant hospitalization duration.