Albumin mass balance and kinetics in liver transplantation

Mariam Amouzandeh,Anna Januszkiewicz,Greg Nowak,Olav Rooyackers,Jan Wernerman,Åke Norberg

doi:10.1186/s13054-018-2053-6

Mariam Amouzandeh, Anna Januszkiewicz + Show 4 more

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https://doi.org/10.1186/s13054-018-2053-6

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Abstract

BackgroundIn major abdominal surgery albumin is shifted from the circulation, presumably leaking into the interstitial space, contributing to a 30–40% decrease in plasma albumin concentration. During and after liver transplantation exogenous albumin is infused for volume substitution and to maintain plasma albumin concentration. Here we used liver transplantation as a model procedure for the study of albumin mass balance and kinetics during major abdominal surgery with albumin substitution.MethodsPatients were studied during liver transplantation (n = 16), and until postoperative day 3 (POD 3) (n = 11). Cumulative perioperative albumin shift was assessed by mass balance of albumin and hemoglobin. Synthesis rates of albumin and fibrinogen were estimated by the flooding technique using deuterium-labeled phenylalanine. Albumin distribution was assessed by radioiodinated human serum albumin.ResultsAt the end of surgery, 37 ± 17 g of albumin (p < 0.0001) had shifted from plasma, and this amount was stable until POD 3 (48 ± 33 g, p = 0.0017 versus baseline). There was 91 ± 37 g exogenous albumin infused peroperatively and another 47 ± 35 g was infused postoperatively until POD 3. Absolute synthesis rates of albumin and fibrinogen on POD 3 were 239 ± 84 mg/kg body weight/day and 33 mg/kg body weight/day (range 5–161), respectively.ConclusionsAlbumin net leakage from plasma progressed until the end of surgery, and was then unaltered until POD 3. This is in contrast with the normalization of the cumulative albumin shift identified at day 3 after non-transplant major abdominal surgery. Liver synthesis of export proteins was high compared to reference values at the third postoperative day, suggesting rapid recovery of synthesis capacity.Trial registrationSwedish Medical Product Agency, EudraCT 2015-002568-18. Registered on 15 July 2015.

Highlights

In major abdominal surgery albumin is shifted from the circulation, presumably leaking into the interstitial space, contributing to a 30–40% decrease in plasma albumin concentration
We demonstrated a cumulative perioperative albumin shift from plasma of 24 ± 17 g, presumably to the interstitial space, 1 h after the end of major abdominal surgery [13]
In the absence of published data on patients undergoing liver transplantation, we looked at our previous study in patients undergoing major abdominal surgery where the albumin shift was 24 ± 17 g, corresponding to an effect size of 1.4 [13]

Summary

Introduction

In major abdominal surgery albumin is shifted from the circulation, presumably leaking into the interstitial space, contributing to a 30–40% decrease in plasma albumin concentration. By keeping rigorous track of infusions of exogenous albumin and losses of albumin by bleeding and in drains, we have adapted a method of mass balance. Using this approach, we demonstrated a cumulative perioperative albumin shift from plasma of 24 ± 17 g, presumably to the interstitial space, 1 h after the end of major abdominal surgery [13]. We demonstrated a cumulative perioperative albumin shift from plasma of 24 ± 17 g, presumably to the interstitial space, 1 h after the end of major abdominal surgery [13] Whether this loss can be affected by intravenous administration of exogenous albumin is not known

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