Preoperative Serum Albumin Levels Predict One-Year Postoperative Survival of Patients Undergoing Heart Transplantation Kato et al: Albumin and Post Heart Transplant Survival

Background—Serum albumin concentration has been recognized as a marker of nutrition, severity of inflammation and hepatic function in patients with various chronic diseases. The purpose of this study was to investigate the impact of pre-transplant serum albumin concentration on post-transplant outcome in heart transplant (HTx) recipients. Methods and Results—Pre-operative laboratory variables including albumin concentration as well as donor-related information were obtained from 822 consecutive patients undergoing HTx at Columbia University Medical Center between 1999 and 2010. The association between pre-transplant albumin concentration and post-transplant one-year survival was analyzed. Available data from the United Network of Organ Sharing (UNOS) (n=13,671) was also analyzed to evaluate the impact of pre-operative albumin levels on post-transplant outcome. In our cohort, multivariable analysis revealed that preoperative albumin (mg/dL) [hazard ratio (HR) 0.46, p<0.0001] and pre-operative total bilirubin (mg/dL) (HR 1.26, p=0.0002) were associated with post-transplant one-year mortality. This implied that for every 1 mg/dL increase in albumin concentration, the post-transplant one-year mortality rate decreased by 54%. The Kaplan-Meier analysis based on our patients cohort and the UNOS dataset showed lower survival rate at one-year pos-transplant in patients with albumin levels 3.5mg/dL compared to those with >3.5mg/dL (Our patients, 91.3 vs. 72.4%, p<0.0001; UNOS, 88.4 vs. 84.8%, p<0.0001). Conclusions—Pre-transplant serum albumin concentration is a strong prognostic marker for post-transplant survival in HTx recipients.