Pre‐transplant hypoalbuminemia is not associated with worse short‐term outcomes among kidney transplant recipients

Abstract Introduction Serum albumin is an indicator of overall health status, but it remains unclear how pre‐transplant hypoalbuminemia is associated with early post‐transplant outcomes. Methods This study included all adult kidney transplant recipients (KTRs) at our center from 01/01/2001–12/31/2017 with serum albumin measured within 30 days before transplantation. KTRs were grouped based on pretransplant albumin level normal (≥4.0 g/dL), mild (≥3.5 – < 4.0g/dL), moderate (≥3.0 – < 3.5g/dL), or severe hypoalbuminemia (<3.0g/dL). Outcomes of interest included: length of hospital stay (LOS), readmission within 30 days, delayed graft function(DGF), and re‐operation related to post‐transplant surgical complications. We also analyzed rejection, graft failure, and death within 6 months post‐transplant. Results A total of 2807 KTRs were included 43.6% had normal serum albumin, 35.3% mild, 16.6% moderate, and 4.5% severe hypoalbuminemia. Mild and moderate hypoalbuminemia were associated with a shorter LOS by 1.22 ( p < 0.001) and 0.80 days ( p = 0.01), respectively, compared to normal albumin. Moderate (HR: 0.58; 95% CI: 0.37‐0.91; p = 0.02) and severe hypoalbuminemia (HR: 0.21; 95% CI: 0.07–0.68; p = 0.01) were associated with significantly lower rates of acute rejection within 6 months post‐transplant. Conclusion Patients with pre‐transplant hypoalbuminemia have post‐transplant outcomes similar to those with normal serum albumin, but with a lower risk of acute rejection based on the degree of hypoalbuminemia.