title: Associations of pretransplant serum albumin with post-transplant outcomes in kidney transplant recipients.
abstract: The association between pretransplant serum albumin concentration and post-transplant outcomes in kidney transplant recipients is unclear. We hypothesized that in transplant-waitlisted hemodialysis patients, lower serum albumin concentrations are associated with worse post-transplant outcomes. Linking the 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, we identified 8961 hemodialysis patients who underwent first kidney transplantation. Mortality or graft failure and delayed graft function (DGF) risks were estimated by Cox regression (hazard ratio [HR]) and logistic regression (Odds ratio [OR]), respectively. Patients were 48 ± 13 years old and included 37% women and 27% diabetics. The higher pretransplant serum albumin was associated with lower mortality, graft failure and DGF risk even after multivariate adjustment for case-mix, malnutrition-inflammation complex and transplant related variable. Every 0.2 g/dL higher pretransplant serum albumin concentration was associated with 13% lower all-cause mortality (HR = 0.87 [95% confidence interval: 0.82-0.93]), 17% lower cardiovascular mortality (HR = 0.83[0.74-0.93]), 7% lower combined risk of death or graft failure (HR = 0.93[0.89-0.97]) and 4% lower DGF risk (OR = 0.96[0.93-0.99]). Hence, lower pretransplant serum albumin level is associated with worse post-transplant outcomes. Clinical trials to examine interventions to improve nutritional status in transplant-waitlisted hemodialysis patients and their impacts on post-transplant outcomes are indicated.
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
authors: M Z
authors: MZ
authors: Molnar
authors: C P
authors: CP
authors: Kovesdy
authors: S
authors: S
authors: Bunnapradist
authors: E
authors: E
authors: Streja
authors: R
authors: R
authors: Mehrotra
authors: M
authors: M
authors: Krishnan
authors: A R
authors: AR
authors: Nissenson
authors: K
authors: K
authors: Kalantar-Zadeh
mesh_terms: D000328:Adult; D015331:Cohort Studies; D048909:Diabetes Complications / Q000628:therapy; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007249:Inflammation; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D012306:Risk; D012709:Serum Albumin / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin