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Kidney Week

Abstract: PO2115

Pre-Transplant Hypoalbuminemia Is Associated with Lower Risk for Rejection Among Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Khan, Aahad Nawaz, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Srivastava, Aniruddha, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Aziz, Fahad, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Garg, Neetika, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Mohamed, Maha A., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Djamali, Arjang, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Parajuli, Sandesh, University of Wisconsin-Madison, Madison, Wisconsin, United States
Background

Serum albumin is a marker of health status. Hypoalbuminemia is a common complication among patients with end-stage renal disease. Many patients would have hypoalbuminemia before getting a kidney transplant. The association of hypoalbuminemia and early post kidney transplant outcomes is not well studied.

Methods

All adult kidney transplant recipients at our center between 01/01/2001 and 12/31/2017 who had serum albumin levels ≤30 days prior to transplantation were included. Categorized recipients into four pretransplant albumin levels: normal albumin (≥4.0 gm/dL, reference group), mild (≥3.5-<4.0), moderate (≥3.0-<3.5), and severe (<3.0). We looked at pre-transplant hypoalbuminemia and outcomes incuding length of stay after transplant, readmission within 30 days, delayed graft failure, need for re-operation related to transplant. We also looked for the rate of rejection, graft failure, and death within the first six months of transplant.

Results

2807 patients were included in the study. Of those, 1224 were identified as normal, 992 with mild, 466 with moderate, and 125 with severe. Albumin groups differed by age (p<0.001), BMI (p<0.001), pre-transplant dialysis (p=0.0011), cause of ESRD (p<0.001), and induction agent (p<0.001). The mild group was associated with -1.24 days less LOS (95% CI -1.73 to -0.75; p<0.001); and moderate by -0.82 day (95% CI -1.46 to -0.19, p=0.01) but not a significant difference in severe group, after adjustment of multiple confounding factors, compared to reference. There were no differences in the rate of DGF, re-hospitalization within 30 days across the groups. The moderate group was associated with a lower need for re-operation (HR: 0.39; 95% CI: 0.17 to 0.89; p=0.025). The moderate (HR: 0.54, 95% CI: 0.30-0.85; p=0.008) and severe (HR: 0.20, 95% CI: 0.06-0.65; p=0.007) groups were associated with a significantly lower rejection rate within six months compared to reference levels.

Conclusion

Our results suggest that the hypoalbuminemia is associated with a lower risk of acute rejections and some other complications, were also comparable compared to recipients with normal albumin levels. These findings may guide transplant providers in the selection of patients and anticipate and mitigate some of the post-transplant complications.