ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO1140

Serum Albumin Levels Prior to Kidney Transplant Predicts Post-Transplant BK and Cytomegalovirus Infections

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Srivastava, Aniruddha, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Bodnar, Josh, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., UW Health, Madison, Wisconsin, United States
  • Parajuli, Sandesh, UW Health, Madison, Wisconsin, United States
Background

Post-transplant Infections are a common cause of morbidity and mortality in kidney transplant recipients (KTRs). Prior studies have shown that pre- and post-transplant hypoalbuminemia are associated with graft failure and all-cause mortality. Others suggested that low post-transplant albumin is linked to cytomegalovirus (CMV) infections. These studies suggest serum albumin levels could indicate post-transplant infection risks. Our study evaluated the association between pre-transplant serum albumin and post-transplant BK Virus (BKV) and Cytomegalovirus (CMV) infections in KTRs.

Methods

We used our university database to identify adult KTRs transplanted between 01/01/2005 and 12/31/2015. All subjects had serum albumin measured within 45 days before the transplant. We categorized all KTRs into three pre-transplant albumin levels: Group 1: normal serum albumin ≥ 4.0 g/dL, Group 2: moderate hypoalbuminemia 2.5-3.9 g/dL, and Group 3: severe hypoalbuminemia < 2.5 g/dL. We used incidence models per 100 person-years and Cox proportional hazards to compare outcomes between groups.

Results

1717 patients were included in the study. Of those, 36.2% (n=622) were identified as group 1, 62.3% (n=1070) as group 2, and 1.4% (n=25) as group 3. Albumin groups differed by age, cause of end-stage renal disease, BMI, induction immunosuppression and maintenance immunosuppression with tacrolimus vs other, all with a p-value less than 0.001. Incidence of BK viremia for group 1 was 2.2 per 100 person-year which was lower, compared with group 2: 4.6/100 person-year and group 3: 9.9/100 person-year; as well as for CMV viremia, group 1: 1.75/100 person-year, group 2: 2.7/100 person-year and group 3: 3.6/100 person-year. The adjusted relative hazard for BK was also higher for group 2 (HR=1.25, 95% CI[0.95 -1.6]) and group 3 (HR=2.3, 95% CI[1.0-4.9]) compared to group 1. A similar trend was found for CMV for group 2 (HR=1.1, 95% CI[0.77-1.53]) and group 3 (HR=1.4, 95% CI (0.43-4.5])

Conclusion

Our results suggest that the degree of hypoalbuminemia pre-transplant is directly correlated with the risk of BKV and CMV post-transplant. Proper screening and management of hypoalbuminemia may be helpful in reducing the future risk of these infections.