The impact of hypoalbuminemia in kidney-pancreas transplant recipients.

Abstract

BACKGROUND:

Hypoalbuminemia is associated with poorer outcomes in renal transplantation. Diabetes can compound hypoalbuminemia's detrimental effects. Kidney-pancreas transplantation alters the diabetic milieu; yet, some patients continue to be hypoalbuminemic.

METHODS:

We retrospectively analyzed 232 patients who underwent simultaneous kidney-pancreas transplantation (SPK) between 1993 and 1997 to determine the incidence and clinical correlates of hypoalbuminemia in SPK recipients. Post-SPK hypoalbuminemia was defined as a serum albumin level < or =3.5 g/dl. Univariate analyses were performed to determine whether post-SPK hypoalbuminemia was associated with pre-SPK variables. The effect of albumin level and hypoalbuminemia on the risk of post-SPK events (cardiac events, cytomegalovirus [CMV] infection, rejection, readmission, kidney and pancreas graft failure, and death) was examined with a Cox proportional hazards model.

RESULTS:

The study population consisted of 149 men and 83 women. Average follow-up was 2.0+/-1.3 years. Hypoalbuminemia (serum albumin level < or =3.5 g/dL) was most common early after SPK (3 months: 44% of evaluable patients were hypoalbuminemic; 12 months: 15.3%; 36 months: 8.3%). Acute rejection episodes and readmission were the most common adverse events after SPK transplantation. There were 24 episodes of renal allograft loss and only 5 cardiac events. Ten SPK recipients died during the study time period. SPK-related hypoalbuminemia was associated with an increased risk for CMV infection (risk ratio [RR] 2.5; P<0.02), renal graft failure (RR 2.41; P=0.05), pancreas graft failure (RR 3.66; P=0.01), and a trend toward an increased risk for death (RR 2.8; P=0.19).

CONCLUSIONS:

Post-SPK hypoalbuminemia resolves over time in many patients. Persistent post-SPK hypoalbuminemia is associated with an increased risk for CMV infection, graft loss, and a trend toward decreased survival. Efforts to improve nutrition, as it may affect hypoalbuminemia in SPK recipients, may be one strategy for improving SPK outcomes.

• Authors: B N Becker, Y T Becker, D M Heisey, G E Leverson, B H Collins, J S Odorico, A M D'Alessandro, S J Knechtle, J D Pirsch, H W Sollinger
• Journal: Transplantation (Transplantation) Vol. 68 Issue 1 Pg. 72-5 (Jul 15 1999) ISSN: 0041-1337 [Print] United States
• PMID: 10428270 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Serum Albumin

Topics

• Aged
• Cytomegalovirus Infections (epidemiology, etiology)
• Diabetes Mellitus, Type 1 (physiopathology, surgery)
• Female
• Graft Survival (physiology)
• Humans
• Kidney Transplantation (adverse effects)
• Male
• Middle Aged
• Pancreas Transplantation (adverse effects)
• Risk Factors
• Serum Albumin (deficiency)