Abstract: FR-PO1140
Serum Albumin Levels Prior to Kidney Transplant Predicts Post-Transplant BK and Cytomegalovirus Infections
Session Information
- Transplantation: Clinical - Post-Transplant Complications
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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.