title: 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.affiliation: Department of Medicine, University of Wisconsin Medical School, Madison 53792, USA. bnb@medicine.wisc.edu
authors.forename: B N
authors.initials: BN
authors.lastname: Becker
authors.forename: Y T
authors.initials: YT
authors.lastname: Becker
authors.forename: D M
authors.initials: DM
authors.lastname: Heisey
authors.forename: G E
authors.initials: GE
authors.lastname: Leverson
authors.forename: B H
authors.initials: BH
authors.lastname: Collins
authors.forename: J S
authors.initials: JS
authors.lastname: Odorico
authors.forename: A M
authors.initials: AM
authors.lastname: D'Alessandro
authors.forename: S J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: J D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: H W
authors.initials: HW
authors.lastname: Sollinger
mesh_terms: D000368:Aged; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects; D012307:Risk Factors; D012709:Serum Albumin / Q000172:deficiency*
chemical_list: D012709:Serum Albumin