Prognostic Value of Liver Function-based Scores in Hepatocellular Carcinoma Patients Undergoing Liver Transplantation

<h3>Background/Aim:</h3> Long-term outcomes after liver transplantation (LT) for hepatocellular carcinoma (HCC) vary widely, highlighting the need for reliable prognostic markers. This study evaluated the prognostic value of liver function-based metrics, namely albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI), for survival and recurrence post transplant. <h3>Patients and Methods:</h3> This retrospective study included 69 adult patients with HCC who underwent LT between January 2004 and June 2025. Patients were stratified by ALBI and PALBI grade, and survival outcomes were compared using Kaplan-Meier analysis. Multivariate Cox regression models assessed the independent prognostic value of these measures. <h3>Results:</h3> Higher ALBI and PALBI grades were associated with significantly worse OS and RFS (log-rank <i>p</i>&lt;0.05), while the Child-Pugh score was not statistically significant in relation to overall survival and recurrence-free survival (<i>p</i>=0.393). Median OS decreased with increasing ALBI grade (grade I: 13.8 years, grade II: 12.2 years, and grade III: 2.7 years). In multivariate analysis, PALBI grade was an independent predictor of OS (<i>p</i>&lt;0.001), while the Child-Pugh score had limited prognostic value (<i>p</i>=0.400). <h3>Conclusion:</h3> This two-decade study highlights the prognostic value of the pre-transplant ALBI and PALBI scores in predicting post-transplant survival and recurrence in patients with HCC. These scores, especially PALBI, provide objective assessments that enhance risk stratification and guide tailored postoperative surveillance strategies. Further validation in larger, multicenter studies is needed to confirm their clinical utility in the setting of LT after HCC.