title: The impact of pretransplantation serum albumin levels on long-term renal graft outcomes.
abstract: BACKGROUND
  The association between pretransplantation serum albumin concentrations and renal graft outcomes is unclear. Hypoalbuminemia is a strong predictor of cardiovascular and all-cause mortality in chronic renal disease. Protein-energy wasting in dialysis patients is associated with irreversible damage and an increased risk of adverse outcomes. In this retrospective study, we investigated the association between preoperative albumin levels and short-term as well as long-term renal graft outcomes.
  
  
  METHODS
  We included 375 renal transplant recipients in our center between 1991 to 2011, who were grouped according to their preoperative serum albumin levels: group I (<3.5 g/dL), group II (3.5-3.9 g/dL), group III (4.0-4.4 g/dL), and group IV (≥ 4.5 g/dL). We measured the frequencies of delayed graft function (DGF), acute rejection episodes, and viral infections as well as the long-term graft outcomes.
  
  
  RESULTS
  DGF affected 12.8%, 6.8%, 7.7%, and 9.3% of patients in groups I-IV, respectively. Acute rejection occurred in 27.7%, 27.2%, 31.6%, and 24.1%, while cytomegalovirus (CMV) and fungal infection occurred in 12.8% (6.4%), 23.3% (5.8%), 16.2% (2.6%), and 11.1% (5.6%) of patients, respectively. Serum creatinine levels at 12 months were not significantly different among the groups. Long-term graft survival was poorest in group I and best in group IV (P = .039). A Cox proportional hazards model showed group IV compared with group displayed the lowest relative risk of graft failure (hazard ratio [HR] = .536; P = .029).
  
  
  CONCLUSIONS
  Low pretransplantation serum albumin levels were associated with poor long-term graft outcomes and with more post-transplantation complications. It may be necessary to focus on improving patients' nutritional status prior to transplantation to ensure long-term renal graft survival.
authors.affiliation: Department of Surgery, Hanyang University Hospital, Seoul, Korea.
authors.forename: S W
authors.initials: SW
authors.lastname: Yang
authors.forename: J Y
authors.initials: JY
authors.lastname: Choi
authors.forename: O J
authors.initials: OJ
authors.lastname: Kwon
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*
chemical_list: D012709:Serum Albumin; D003404:Creatinine