title: Preoperative serum albumin levels predict 1-year postoperative survival of patients undergoing heart transplantation.
abstract: BACKGROUND
  Serum albumin concentration has been recognized as a marker of nutrition, severity of inflammation, and hepatic function in patients with various chronic diseases. The purpose of this study was to investigate the impact of pretransplant serum albumin concentration on post-transplant outcome in heart transplant recipients.
  
  
  RESULTS
  Preoperative laboratory variables, including albumin concentration and donor-related information, were obtained from 822 consecutive patients undergoing heart transplant at Columbia University Medical Center between 1999 and 2010. The association between pretransplant albumin concentration and post-transplant 1-year survival was analyzed. Available data from the United Network for Organ Sharing (n=13671) were also analyzed to evaluate the impact of preoperative albumin levels on post-transplant outcome. In our cohort, multivariable analysis revealed that preoperative albumin (mg/dL; hazard ratio, 0.46; P<0.0001) and preoperative total bilirubin (mg/dL; hazard ratio, 1.26; P=0.0002) were associated with post-transplant 1-year mortality. This implied that for every 1 mg/dL increase in albumin concentration, the post-transplant 1-year mortality rate decreased by 54%. The Kaplan-Meier analysis based on our patients cohort and the United Network for Organ Sharing dataset showed lower survival rate at 1-year post-transplant in patients with albumin levels ≤ 3.5 mg/dL compared with those with >3.5 mg/dL (our patients, 91.3 versus 72.4%; P<0.0001; United Network for Organ Sharing, 88.4 versus 84.8%; P<0.0001).
  
  
  CONCLUSIONS
  Pretransplant serum albumin concentration is a strong prognostic marker for post-transplant survival in heart transplant recipients.
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Faisal H
authors.initials: FH
authors.lastname: Cheema
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yang
authors.forename: Yumeko
authors.initials: Y
authors.lastname: Kawano
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Maryjane
authors.initials: M
authors.lastname: Farr
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Baldwin
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: P Christian
authors.initials: PC
authors.lastname: Schulze
mesh_terms: D000328:Adult; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057234:Preoperative Period; D011379:Prognosis; D012709:Serum Albumin / Q000032:analysis*
chemical_list: D012709:Serum Albumin
keywords: albumin; heart transplantation; prognosis