IS PRE OPERATIVE SERUM ALBUMIN OF PROGNOSTIC VALUE IN RENAL TRANSPLANTATION?

Abstract

A91 Aims: Low albumin levels are associated with increased complication rates in general surgery. No study has dealt with this factor in the context of renal transplantation. We wished to know if preoperative serum albumin level is associated to complications in renal transplant recipients. Methods: Data was reviewed retrospectively on all patients transplanted during the year 2002. Independent variables studied were: preoperative serum albumin, white blood cell count, hemoglobin, creatinine, weight, height, body mass index (BMI), dialysis modality, donor type, age, and gender. Dependent variables were: post op creatinine, urine output, wound infection, dehiscence, lymphocele, acute tubular necrosis by biopsy (ATN), other complications, length of stay (LOS), post operative weight, return to dialysis and death. Analysis using STAT200® software included parametric and non-parametric statistics. Results: Sixty-four patients were included in the study, 37 male and 27 female. Mean preperative serum albumin was 3.75, median 3.6. No significant gender differences were noted in age (t-test p=0.816), pre operative albumin levels (t-test p=0.708), complication rate (X2 p=0.424) or LOS (t-test p=0.647). Studying the means or setting albumin at 3.5 or 4.0, no significant differences were found in overall complications (X2 p=0.770, t-test p=0.384), ATN (X2 p=0.664, t-test p=0.103), lymphoceles (X2 p=0.544, t-test p=0.990), wound infection (Fisher p=0.497, t-test p=0.569), and LOS (t-test p=0.187). Patients with a pre operative albumin of less than 4 had a lower creatinine level on the second day post transplantation than those higher than 4 (t-test p=0.011). Dialysis modality was a significant factor in postoperative complications (X2 p<0.000) and LOS (t-test p=0.006), peritoneal dialysis better than hemodialysis, but when adjusted for dialysis duration these results were not significant (Fisher p=0.237, t-test p=0.058). Albumin did not differ between dialysis modalities (t-test p=0.136). Dialysis duration of more than 2 years had a higher complication rate and LOS (X2 p<0.0001, t-test p=0.004, respectively). Preoperative weight and BMI were significant factors in wound infection (t-test, p=0.024; p=0.047, respectively), and pre operative weight in overall complications (t-test p=0.032). One of four patients with an albumin <3 had a lymphocele. Conclusions: Pre operative albumin, if greater than 3.0, was not a prognostic indicator for the development of surgical complications following renal transplantation. Only preoperative weight, BMI and dialysis duration were significant factors in the development of postoperative complications and prolonged hospital stay.