Kidney Week

Abstract: TH-PO1027

Association of Pretransplant Serum Albumin with All-Cause Mortality in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical - Outcomes, Malignancy, and Pathology
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Tantisattamo, Ekamol, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Ekamol Tantisattamo, MD, MPH, FASN

• Chalermchat, Thanasin, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Thanasin Chalermchat

• Deepan, Natee, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Natee Deepan, MD

• Ansusinha, Parinda, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Parinda Ansusinha, MD

• Asawaroekwisoot, Thanin, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Thanin Asawaroekwisoot, MD

• Chamnarnphol, Natanon, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Natanon Chamnarnphol, MD

• Tangprasittichok, Nathasith, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Nathasith Tangprasittichok, MD

• Kitlertbanchong, Nitchanan, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Nitchanan Kitlertbanchong, MD

• Siwawut, Katanyu, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Katanyu Siwawut, MD

• Mohpichai, Nopavit, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Nopavit Mohpichai

• Ngamvirojcharoen, Boonyasit, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Boonyasit Ngamvirojcharoen, MD

• Chongthanadon, Brandon, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Brandon Chongthanadon, MD

• Limpiwattakee, Suppalux, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Suppalux Limpiwattakee, MD

• Silprasert, Raynah Roypim, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Raynah Roypim Silprasert

• Kasebuthtaweewat, Yodsaphong, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Yodsaphong Kasebuthtaweewat, MD

• Chuenchaem, Urairat, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Urairat Chuenchaem, MD

• Noree, Wanprapit, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Wanprapit Noree, MD

• Bunyawannukul, Issaree, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States

Issaree Bunyawannukul, MD

• Kookanok, Chutawat, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Chutawat Kookanok, MD

• Kulthamrongsri, Narathorn, American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, United States

Narathorn Kulthamrongsri, MD

• Lauhawatana, Burin, Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Burin Lauhawatana, MD

• Wiwattanathum, Punlop, Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Punlop Wiwattanathum, MD

• Arpornsujaritkun, Nuttapon, Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Nuttapon Arpornsujaritkun, MD

• Jittirat, Arksarapuk, Division of Nephrology and Hypertension, Department of Medicine, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

Arksarapuk Jittirat, MD

• Kantachuvesiri, Surasak, Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Surasak Kantachuvesiri, MD

Background

Magnitude of pre-transplant serum albumin (SA) and mortality in kidney transplant recipients (KTR) is unknown. We aim to examine the association of pre-transplant SA with all-cause mortality in this population.

Methods

A retrospective cohort study using the UNOS data included patients undergoing kidney transplant between November 17, 1987 and December 31, 2024 and had SA data. Patients were categorized into 10 groups based on the decile of pre-transplant SA. The association between SA and time-to-all-cause mortality was examined by multiple Cox regression analyses.

Results

Of 603,670 adult KTR, the mean±SD age was 53±14 years, and 61% were male. SA ranges between 0.5 and 9.9 g/dL with a median (IQR) SA of the KTR in the decile 5 was 4 (3.9, 4) g/dL (Fig 1A). During the median follow-up of 4.8 (2, 8.8) years (range <1 - 37 years), 85,552 patients died. Mortality rate was 0.049 person-years with a median survival of 12.3 years. Compared to KTR in decile 1, KTR in other deciles had graded higher risk of death (HR_{decile 2 to 10} 0.93 to 0.64; P <0.0001; (Fig 1B). After adjusting for age, gender, race, BMI, pre-transplant Karnofsky score, diabetes, PVD, proteinuria, dialysis vintage, donor’s serum creatinine, A-B-DR and total HLA mismatches, total cPRA, history of DGF, acute rejection, citizenship, level of education, and interaction term between SA and age (<65 vs. ≥65), the magnitude and direction of the association remained (aHR 0.93-0.75; P <0.0001). Age was an effect modifier with a higher mortality rate observed in older KTR except those in deciles 2, 4, 6, and 7 which had a mean SA of 3.4, 3.8, 4.1, and 4.2 g/dL, respectively.

Conclusion

Pre-transplant SA is positively associated with all-cause mortality in KTR, especially in elderly. As one of the surrogate markers of nutritional status, pre-transplant SA should be maximized to mitigate poor outcomes in KTR.

Acknowledgment

OPTN/SRTR for data used for analyses.