Blood Problem Linked to Transplant Loss

Low serum albumin in chronic kidney disease associated with kidney transplant failure in children

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Kidney transplants can save the lives of children with kidney failure. But not all children's bodies accept the new kidneys. After transplant surgery, the goal for doctors is to keep the new organ in good running order.

A blood condition - called low serum albumin - has been linked to a greater risk of kidney failure in young kidney transplant recipients.

"Sign up as an organ donor today!"

Lavjay Butani, MD, of the University of California, Davis, and Daniel Tancredi, PhD, also of UC Davis, found that low serum albumin may increase the risk of complications and death in children who received a kidney transplant.

About one in four children receiving a kidney transplant had low serum albumin - a condition in which levels of albumin in the blood are low. Many hormones and drugs need to bind to albumin to work properly. Low levels of albumin can be a sign of liver damage and other health problems.

Every year, about one out of 65,000 children develop end-stage renal disease (the complete or near-complete failure of kidney function). The main way to treat kidney failure in children is a kidney transplant.

"Even a single low serum albumin measurement at the time of listing the patient on a transplant registry is clearly a risk factor for graft failure in the future," said Dr. Butani.

"Transplant centers should very carefully consider proceeding with the transplant in children with very low serum albumin, because of its association with a moderately higher risk of graft failure," he said.

Extending the life of a transplanted kidney is important, said Dr. Butani, because a longer transplant survival means fewer children need to get a second transplant.

To see if patients with low serum albumin before transplant surgery had worse outcomes than those with normal albumin levels, Drs. Butani and Tancredi looked at the records of about 6,000 children who had received a kidney transplant between January 2000 and December 2010. All of the patients received transplants through the Organ Procurement and Transplantation Network.

About 5 percent of these children had very low levels of serum albumin (less than 2.5 grams per deciliter). These patients were almost twice as likely as those with the highest albumin levels to experience a kidney transplant failure within one year of surgery (a risk of 8.3 percent).

About 20 percent of the study's participants had intermediate levels of of albumin (between 2.5 and 3.5 grams per deciliter). Among these patients, the risk of kidney transplant failure was 6.2 percent.

The researchers also found that increasing levels of serum albumin was associated with a decreasing risk of transplant failure. That is, every gram-per-deciliter increase in albumin was associated with a 20 percent drop in the risk of transplant failure over an average of four years.

While this research highlighted an association between low serum albumin and kidney transplant failure, the researchers could not say that low albumin is the direct cause of transplant failure.

"Although our study can assess whether an association exists, further research is necessary to determine if there is a cause-effect relationship," said Dr. Tancredi.

Until researchers discover the actual cause, said Batani, "for a child with chronic kidney disease who has a low serum albumin level, the presence of a modestly elevated risk of graft failure is something that will need to be discussed with the patient, the family and the entire transplant team."

The research was presented at the 24th International Congress of the Transplantation Society in Berlin. The study has yet to be published in a peer-reviewed journal.

Reviewed by: 
Review Date: 
July 20, 2012
Last Updated:
February 5, 2013