: Albumin-Bilirubin score (ALBI) was primarily developed to quantify the liver function and to prognosticate the patients with hepatocellular carcinoma. Later, it was shown that the ALBI score could predict postoperative complications after liver resection and transplantation.

: A retrospective analysis was conducted to evaluate the preoperative ALBI score as a predictor of post-living donor liver transplant (LDLT) outcomes. This study included 190 patients from August 2019 to 2021. The predictive power of this variable was assessed using Receiver Operating Characteristic (ROC) analysis.

: In total, 190 LDLT recipients were included in this study. Twelve patients (6.3%) belonged to ALBI Grade 1, 82 patients (43.2%) belonged to ALBI Grade 2, and 96 patients (50.5%) belonged to ALBI Grade 3. Similar to the Model for End-stage Liver Disease (MELD), a high ALBI score implies poor liver function, and a low ALBI score implies a better-preserved state. The preoperative ALBI score predicted morbidity with an area under the curve (AUC) of 0.66, whereas the preoperative MELD score predicted morbidity with an AUC of 0.70. For 90-day mortality prediction, preoperative ALBI demonstrated an AUC of 0.60, whereas preoperative MELD showed an AUC of 0.63. ROC curve analysis revealed that the optimal ALBI score cutoff value for differentiating between survivors and non-survivors was -1.40. The discrimination ability of ALBI was higher in patients with high MELD scores (MELD ≥18).

: In predicting both morbidity and 90-day mortality, the performance of the ALBI score was comparable to that of the preoperative MELD. The discriminatory power of ALBI was higher in patients with high MELD scores.