Pretransplant Serum Albumin Is an Independent Predictor of Graft Failure in Pediatric Renal Transplant Recipients

Objectives To determine the prevalence of hypoalbuminemia in children listed for renal transplantation and to evaluate the effect of pretransplant hypoalbuminemia on posttransplant outcomes. Study design Retrospective cohort analysis of children receiving their first kidney transplant in the US between January 2000 and December 2010 obtained through the Organ Procurement and Transplantation Network. The primary outcome measure was time to graft failure. Cox regression analyses were used to estimate the independent effect of serum albumin on event incidence. Results Of the 6032 children who received transplants, 308 (5.1%) had a very low serum albumin level at registration; rates of transplantation in such children varied significantly across geographic regions (chi(2), P < .001) ranging from 2.1% to 8.7%. Serum albumin was inversely associated with graft failure; each 1-g/dL increase in serum albumin was associated with a 19% reduction in risk of graft failure (adjusted hazard ratio 0.81, 95% CI 0.75-0.88, P < .001). Conclusions Considerable regional variation exists in the US with respect to transplantation in children with hypoalbuminemia. Severe hypoalbuminemia is an independent risk factor for graft failure. Transplant centers as well as patients need to be aware of this risk and make informed decisions regarding the optimal timing of transplantation. Whether graft failure is a consequence of the low serum albumin or the reflection of a higher inflammatory milieu remains to be explored.