Association between early postoperative hypoalbuminemia and outcome after orthotopic heart transplantation.

OBJECTIVES: In patients undergoing heart transplantation (HTX), preoperative liver impairment and consecutive hypoalbuminemia are associated with increased mortality. The role of early postoperative hypoalbuminemia after HTX is unclear. This study investigated the association between early postoperative hypoalbuminemia and 1-year mortality as well as "days alive and out of hospital" (DAOH) after HTX.

METHODS: This retrospective cohort study included patients who underwent HTX at the University Hospital Duesseldorf, Germany between 2010 and 2022. The main exposure was serum albumin concentration at ICU arrival. The primary end-points were mortality and DAOH within one year after surgery. Receiver Operating Characteristic (ROC) curve analysis was performed and logistic and quantile regression models with adjustment for 13 a priori defined clinical risk factors were conducted.

RESULTS: Out of 241 patients screened, 229 were included in the analysis (mean age 55 ± 11 years, 73% male). ROC analysis showed moderate discrimination for one-year mortality by postoperative serum albumin after HTX [AUC = 0.74 95% CI: 0.66-0.83]. The cut-off for serum albumin at ICU arrival was 3.0 g/dl. According to multivariate logistic and quantile regression, there were independent associations between hypoalbuminemia and mortality/DAOH (Odds ratio of 4.76 [95% CI 1.94-11.67] and regression coefficient of -46.97 [95% CI -83.81 - -10.13]).

CONCLUSIONS: Postoperative hypoalbuminemia <3.0 g/dl is associated with 1-year mortality and reduced DAOH after HTX and therefore might be used for early postoperative risk re-assessment in clinical practice.