THE IMPACT OF HYPOALBUMINEMIA IN SIMULTANEOUS KIDNEY-PANCREAS TRANSPLANT RECIPIENTS

Abstract

364 Hypoalbuminemia is associated with poorer outcomes in renal transplantation(AJKD 27:117-23) and diabetes may compound the effects of hypoalbuminemia on morbidity and mortality in transplant recipients. Kidney-pancreas transplantation (KPTx) alters the pre-existing diabetic milieu. Yet, some patients continue to manifest hypoalbuminemia. We examined the incidence and clinical correlates of hypoalbuminemia pre-KPTx, at 3 months (mos), 6 mos, 9 mos, 1 year, and annually thereafter following KPTx in 232 simultaneous KPTx recipients. The study population consisted of 149 M and 83 F KPTx recipients, transplanted between 1993 and 1997. The mean age for the KPTx recipients was 39.4 ± 5.6 years (mean ± S.D.) Average follow-up was 2.0± 1.3 yrs. Hypoalbuminemia (serum albumin ≤ 3.5 g/dL) was most common early following KPTx and decreased thereafter. At 3 mos. 44% of evaluable patients (n = 106) were hypoalbuminemic. At 6 mos.: 19.7% of patients were hypoalbuminemic (n=119), declining to 15.3% at 12 mos. (n=109), 20.7% at 24 mos. (n=52) and 8.3% at 36 mos. (n=23). Hypoalbuminemia at 6 mos. post-KPTx was significantly associated with pre-KPTx peritoneal dialysis (p< 0.04). Post-KPTx hypoalbuminemia did not correlate with pre-KPTx albumin. Hypoalbuminemia analyzed as a time-dependent variable appeared to increase risk for certain events after KPTx. TableAnalyzing pre-KPTx albumin as a fixed variable over time conjointly with post-KPTx albumin levels suggested that both were associated with decreased survival after KPTx (low pre-KPTx alb: p<0.04; low post-KPTx alb:p<0.05). Thus, early post-KPTx hypoalbuminemia resolves over time. Persistent post-KPTx hypoalbuminemia is associated with an increased risk for CMV infection and graft loss. Moreover, low albumin levels post-KPTx are associated with decreased survival, especially in the setting of pre-KPTx hypoalbuminemia. Efforts to improve poor nutrition as it affects hypoalbuminemia in KPTx recipients might be one strategy for attempting to improve outcomes.