Low serum albumin increases graft failure risk in kidney-transplant children

By MedWire Reporters

Children with hypoalbuminemia undergoing kidney transplantation are at an increased risk for graft failure, US research shows.

In a multivariable adjusted model, the researchers showed that each 1 g/dL increase in serum albumin reduced the risk for graft failure by 20%.

"Even a single low serum albumin measurement at the time of listing the patient on a transplant registry is clearly a risk factor for graft failure in the future," said senior researcher Lavjay Butani (University of California, Davis) in a press statement.

Presenting the findings at the International Congress of the Transplantation Society in Berlin, Germany, the researchers point out that children with chronic kidney disease often have low serum albumin levels, as a result of inflammation, malnutrition, or urinary protein losses.

In the present study, Butani and colleagues assessed post-transplant outcomes in 5922 children who received a kidney between 2000 and 2010. Of these children, 5.1% had a very low serum albumin concentration (<2.5 g/dL) before the surgery.

Serum albumin levels prior to transplantation were inversely associated with graft failure. In a Cox proportional model, each 1 g/dL increase was associated with a 20% reduction in the risk for graft failure over an average follow up of approximately 4 years.

Very low and low serum albumin (2.50‑3.49 g/dL) levels were associated with a 58% and 24% higher risk for graft failure, respectively, compared with patients with serum albumin levels of at least 3.50 g/dL.

"Transplant centers should very carefully consider proceeding with the transplant in children with very low serum albumin, because of its association with a moderately higher risk of graft failure," Butani commented.

The researchers also noted that the rate of kidney transplantation among the different US surgical centers varied, with hospitals in one region proceeding with transplants in just 2.1% of children with very low serum albumin levels, while hospitals in another region proceeded in 8.2% of children with hypoalbuminemia.

This highlights different practice patterns in the USA and should be investigated further, they add.

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