Pretransplant Hypoalbuminemia Is Not Associated with Worse Outcomes among Simultaneous Pancreas and Kidney Transplant Recipients

Background: Hypoalbuminemia is a well-known independent risk factor predictive of worse outcomes in surgical patients. Nonetheless, the role of pre-transplant hypoalbuminemia and its impact on post-transplant outcomes in patients undergoing simultaneous kidney-pancreas (SPK) transplantation remains unclear. Methods: We retrospectively analyzed all SPK recipients at our center from 2001-2022, who had at least 2 weeks of pancreatic graft survival. Serum albumin levels measured within 6 weeks or closer to transplant were included. Recipients were categorized based on pretransplant albumin level normal (≥ 4.0 g/dl, N = 222), mild (≥3.5 - < 4.0 g/dl, N = 190), moderate (< 3.5 g/dl, N = 120). Multivariable logistic regression and Cox proportional hazard models were used to analyze associations with the length of stay (LOS), kidney delayed graft function (DGF), re-hospitalization within 30 days after discharge, and need for return to the operating room (OR) related to transplant surgical complications, along with acute rejection and uncensored and death-censored graft failure, within the first-year post-transplant. Results: A total of 532 SPK recipients were included, 42% had normal serum albumin; 36% had mild and 23% had moderate hypoalbuminemia. The mean pre-transplant albumin level was 4.3 g/dl in normal, 3.7 g/dl in the mild, and 3.0 in the moderate group. After adjustment for multiple variables, with reference to normal pre-transplant albumin level, mild or moderate hypoalbuminemia was not associated with either increased or decreased risk for LOS, DGF, re-hospitalization or return to the OR. Also, mild, or moderate hypoalbuminemia was not associated with risk for either graft rejection or graft failure. Conclusion: Among SPK recipients, pre-transplant hypoalbuminemia is not associated with worse outcomes. Pre-transplant albumin level should not be the determining factor in offering or rejecting these life-saving organs.