S. Atoa1, M. A. Maluccio1, R. S. Mangus1 1Indiana University School Of Medicine,Surgery / Transplant,Indianapolis, IN, USA
Introduction:
Poor nutrition status is associated with worse post-operative outcomes including complications, prolonged hospitalization and increased costs. Malnutrition is associated with weakness and frailty. There are many ways to measure malnutrition and frailty including laboratory markers to assess protein stores, functional tests to assess strength, and body imaging to assess muscle mass. This study uses serum albumin levels, measured before and after transplant, as a marker for nutrition status. We assess the utility of various methods of pre-transplant testing to determine post-transplant nutrition status.
Methods:
Adults patients undergoing liver, kidney or pancreas transplant were included in this study. Nutrition status was assessed using weight and body mass index (BMI), 5 meter walk test and computed tomography assessment of muscle and fat stores. Each of these tests was then correlated with post transplant serum albumin levels. Measures of nutrition status included a scaled scoring of core muscle mass, and visceral and subcutaneous fat stores, protein and albumin serum levels, functional status, body weight and BMI.
Results:
There were 184 patients analyzed. All transplant organ groups had an acute decrease in their serum albumin level in the post-transplant period, with an improvement to the normal range between 20 and 50 days. Liver patients lagged behind the kidney and pancreas groups in resolution of hypoalbuminemia at all time points up to 40 days (p<0.01). Among liver transplant patients, the groups that experienced a better return to normal serum albumin levels included younger patients (
Conclusion:
This study identifies an acute drop in serum albumin that occurs post transplant. This decrease returns to the normal range with kidney sooner than pancreas, which is sooner than for liver patients. Malnutrition is clearly worse for the liver failure patients. Those that resolve their hypoalbuminemia the fastest are those who are female and younger and have good physiologic strength. However, the group with the worst sarcopenia returned to normal faster than those with lesser muscle loss. These findings suggest a physiologic mechanism which stimulates normalization of serum albumin levels, which is a marker for improved nutrition status. This mechanism may be linked to baseline body muscle mass.
