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. 2025 Apr 11;25(1):178.
doi: 10.1186/s12871-025-03016-y.

The association of perioperative serum albumin concentrations with outcome after deceased donor liver transplantation

Paul Lichtenegger  1 , Alexandra Graf  2 , Judith Schiefer  3 , Aylin Bilir  3 , Dagmar Kollmann  4 , Gabriela A Berlakovich  4 , Peter Faybik  3 , David M Baron  3 , Joanna Baron-Stefaniak  3
Affiliations

The association of perioperative serum albumin concentrations with outcome after deceased donor liver transplantation

Paul Lichtenegger et al. BMC Anesthesiol. .

Abstract

Background: Perioperative hypoalbuminemia has been associated with worse outcome after major surgery. Although hypoalbuminemia is common in patients with chronic liver disease and frequently occurs following liver transplantation (LT), data are sparse regarding perioperative hypoalbuminemia and outcome after LT.

Methods: In this single-center retrospective study performed at the Medical University of Vienna, we evaluated adult patients undergoing orthotopic liver transplantation (OLT) between 2004 and 2019. The association between perioperative serum albumin concentrations and survival, acute kidney injury (AKI), and postoperative surgical complications was analyzed using cox and logistic regression models.

Results: In total, 724 patients were analyzed. Serum albumin concentrations decreased from 32.0 ± 6.8 to 22.8 ± 4.8 g/l (nadir within 48 h following OLT). Overall survival was not associated with serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT (Day1: HR:0.988, 95%CI:0.966-1.011, P = 0.306; Day2: HR:1.021, 95%CI:0.991-1.052, P = 0.167; Nadir: HR:0.998, 95%CI:0.971-1.025, P = 0.863). Serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT were not associated with AKI (Day1: OR:0.975, 95%CI:0.949-1.002, P = 0.070; Day2: OR:1.011, 95%CI:0.971-1.053, P = 0.601; Nadir: HR:0.976, 95%CI:0.940-1.013, P = 0.20) or with postoperative complications (Day1: OR:0.997, 95%CI:0.976-1.059, P = 0.80; Day2: OR:1.002, 95%CI:0.973-1.032, P = 0.890; Nadir: HR:0.993, 95%CI:0.966-1.021, P = 0.610). However, we observed an increased risk for initiation of renal replacement therapy with lower serum albumin concentrations on the day preceding initiation (HR = 0.946; 95%CI:0.896-1.000; P = 0.049).

Conclusion: Hypoalbuminemia was not associated with reduced survival, the development of AKI, or postoperative surgical complications after OLT. However, postoperative hypoalbuminemia was associated with the timing of initiating renal replacement therapy after OLT.

Keywords: Acute kidney injury; Hypoalbuminemia; Morbidity; Mortality; Orthotopic liver transplantation; Renal replacement therapy; Survival.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This single-center retrospective study was performed at the Medical University of Vienna after local ethics committee approval (EK 2347/2016) in accordance with the ethical standards laid down in the Declaration of Helsinki. Due to the retrospective design of the study, the requirement for patient consent was waived by the local ethics committee. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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