PURPOSE: Hypoalbuminemia is a predictor of mortality in a variety of disease states and is an indicator of frailty in healthy older adults. We examined the association of serum albumin concentration at transplant listing with the risk of death after lung transplantation.
METHODS: We examined 6,587 adults with interstitial lung disease (ILD), chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) who underwent their first lung transplantation in the United States between 1995 and 2008 using UNOS/OPTN data. We used stratified Cox models, conditional logistic regression, and generalized additive models to examine associations between pre-transplant serum albumin concentration and the risk of death after transplantation while adjusting for recipient, donor, and transplant procedure characteristics.
RESULTS: The median follow-up time was 2.7 years. 22% of patients had severe (0.5-2.9 g/dl) or mild (3.0-3.6 g/dl) hypoalbuminemia, and 21% had a low-normal serum albumin concentration (3.7-3.9 g/dl). Compared to those with normal serum albumin (4.0-5.0 g/dl), adjusted rates of death after transplantation were 34% (95% CI, 11 to 62%) higher for those with severe hypoalbuminemia and 12% (95% CI, 1 to 24%) higher for those with mild hypoalbuminemia. CF and ILD recipients with severe hypoalbuminemia had adjusted risks of death at 1 year that were 137% (95% CI, 39 to 437%) and 73% (95% CI 4 to 191%) higher than those with normal albumin levels, respectively. COPD recipients with hypoalbuminemia did not have an increased in risk of death compared to those with normal albumin levels. The multivariable-adjusted population attributable fraction at 1 year was 11 and 24% for ILD and CF patients, respectively.
CONCLUSIONS: Hypoalbuminemia is an independent risk factor for death after lung transplantation in recipients with ILD and CF, contributing up to 11 and 24% of deaths in the first year after transplantation.
CLINICAL IMPLICATIONS: Efforts to prevent hypoalbuminemia in patients with advanced lung disease who are listed for lung transplant may reduce the risk of death after transplantation. Hypoalbuminemia should be taken into consideration when selecting candidates for lung transplantation.
DISCLOSURE: The following authors have nothing to disclose: Matthew Baldwin, Selim Arcasoy, Ashish Shah, Julia Sze, David Lederer
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