Abstract 13311: Low Serum Albumin Concentration is Associated With Poor Post-Transplant Prognosis in Patients Undergoing Heart Transplantation
Background. The association between post-transplant survival and pre-transplant characteristics in patients (pts) undergoing heart transplantation (HTx) are not yet fully elucidated. Hypoalbuminemia is a marker of malnutrition, inflammation, impaired hepatic synthesis and overall catabolic status. We tested the impact of pre-transplant albumin levels (Alb) on post-transplant outcome in pts undergoing HTx.
Methods. We analyzed 743 pts undergoing HTx at Columbia University Medical Center between 1999 and 2010. Pre-transplant laboratory examination associated with 3-year survival was evaluated by multivariate analysis and its cut-off value was determined by ROC curve. Post-HTx survival for all studied pts was analyzed using Kaplan-Meier analysis and log-rank test. Available data from the United Network of Organ Sharing (UNOS) (n=13,773) was also analyzed.
Results. Serum Alb concentration was lower, and total bilirubin concentration was higher in pts who died within 3 years (n=153) compared to those who survived longer than 3 years (n=513) (3.7±0.7 vs. 4.0±0.6mg/dL, p<0.0001, 1.1±0.8 vs. 1.4±1.8mg/dL, p=0.0087, respectively) in our cohort. Multivariate analysis revealed that Alb concentration was independently associated with death within 3-years post-transplant (Odds ratio 0.55, 95% confident interval 0.41-0.73, p<0.0001) with a cut-off of 3.5 mg/dL. Pts with Alb≤3.5mg/dL showed worse post-transplant survival compared to those with Alb>3.5mg/dL (p<0.0001, Figure). These findings were confirmed by the UNOS dataset showing lower survival of pts with Alb≤3.5mg/dL compared to >3.5mg/dL (3-year and 5-year survival, 77.7 vs. 82.3 %, 71.6 vs. 75.5%, respectively, p<0.0001).
Conclusions. Pre-transplant hypoalbuminemia indicates poor post-transplant prognosis. Attention to correct nutrition, inflammation and hepatic function to normalize serum Alb concentration before HTx could be an effective way to improve post-transplant survival.
- © 2011 by American Heart Association, Inc.