Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK.
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
Nephrology (Carlton). 2019 Aug;24(8):841-848. doi: 10.1111/nep.13481. Epub 2019 Apr 25.
The aim of this retrospective cohort study was to investigate whether pre-operative hypoalbuminaemia (<35 g/L) is associated with adverse outcomes post-kidney transplantation.
Our retrospective, single-centre analysis included all patients who received their kidney transplant between 2007 and 2017, with documented admission albumin levels prior to surgery. Survival analyses were undertaken to explore the relationship of pre-transplant hypoalbuminaemia versus other baseline variables upon post-transplant outcomes.
We analysed 1131 kidney allograft recipients transplanted at our centre (2007-2017), with median follow-up 746 days (interquartile range 133-1750 days). Kidney transplant recipients with pre-operative hypoalbuminaemia were more likely older, female, recipients of deceased-donor kidneys and to have longer cold ischaemic times. Recipients with pre-operative hypoalbuminaemia had longer hospital admissions post-operatively but no difference in delayed graft function rates. There was no difference in 1 year creatinine but recipients with hypoalbuminaemia had reduced risk for cellular rejection. We observed significantly worse patient survival (83.2% vs 90.7%, P < 0.001) and overall graft survival (72.5% vs 82.0%, P < 0.001) for recipients with hypoalbuminaemia vs normal albumin levels, respectively, but no difference in death-censored graft survival. In a Cox regression model, adjusted for baseline pre-operative variables, hypoalbuminaemia was independently associated with an increased risk for overall graft loss after kidney transplantation (hazard ratio 1.468, 95% confidence interval 1.087-1.982, P = 0.012).
Pre-operative hypoalbuminaemia is an independent risk factor for overall graft loss after kidney transplantation. Further work is warranted to investigate the underlying pathophysiology to determine what supportive measures can be undertaken to attenuate adverse post-transplant outcomes.
本回顾性队列研究旨在探讨术前低白蛋白血症（<35g/L）是否与肾移植后不良结局相关。
本回顾性单中心分析纳入了 2007 年至 2017 年间接受肾移植且术前有白蛋白入院记录的所有患者。采用生存分析探讨移植前低白蛋白血症与其他基线变量对移植后结局的关系。
本研究分析了在本中心接受肾移植的 1131 例肾移植受者（2007-2017 年），中位随访时间为 746 天（四分位距 133-1750 天）。术前低白蛋白血症的肾移植受者年龄更大、女性、接受已故供体肾移植、冷缺血时间更长。术前低白蛋白血症的受者术后住院时间更长，但延迟肾功能恢复率无差异。1 年肌酐无差异，但低白蛋白血症患者发生细胞性排斥反应的风险降低。我们观察到低白蛋白血症组患者生存率（83.2% vs 90.7%，P<0.001）和总移植物生存率（72.5% vs 82.0%，P<0.001）明显更差，但无死亡相关移植物生存率差异。在调整基线术前变量的 Cox 回归模型中，低白蛋白血症与肾移植后总移植物丢失风险增加独立相关（风险比 1.468，95%置信区间 1.087-1.982，P=0.012）。
术前低白蛋白血症是肾移植后总移植物丢失的独立危险因素。需要进一步研究其潜在病理生理学机制，以确定可以采取哪些支持措施来减轻不良移植后结局。
