1. The Relationship between Postoperative Serum Albumin Level and Organ Dysfunction after Liver Transplantation.
Results
No differences were found between groups in pre-and intraoperative data.
The average serum albumin level in the HA group was higher than in the LA group.
however, the albumin infusion amount in the HA group was not larger than in the LA group during the first postoperative week.
There were no significant differences in the mean daily SOFA scores between the HA and LA groups (8.7 [ ] vs. 7.1 [ ], P=0.47) .
The HA group had a lower mean cardiovascular SOFA sub-score than the LA group (0.2 [0-0.8] vs. 0.8 [0-1.7], P=0.041)
There were no significant differences between groups in the complication rates (ascites amount, rejection, re-intubation, abdominal re-operation, thrombosis), need for additional treatment (dialysis, pleural effusion drainage), or length of ICU stay.
Kazumasa Hiroi, Takashi Matsusaki, Vika Lemoto, Ryuji Kaku, Hiroshi Morimatsu
OKAYAMA UNIVERSITY HOSPITAL
【Background】
Some studies have shown that postoperative hypoalbuminemia is associated with adverse events such as increased pleural fluids and ascites, acute kidney injury, longer intensive care unit (ICU) stay and death, especially following liver transplantation.
Correction of postoperative hypoalbuminemia would prevent such postoperative complications
In our hospital, we use albumin for the supplement of postoperative ascites(one-half of the amount).
there is one question regarding what level of serum albumin to be maintained postoperatively.
The present study investigated the relationship between postoperative albumin level and organ failure (assessed via the Sequential Organ Failure Assessment [SOFA] score), which has been the standard index for evaluating the severity of organ failure in ICU patients.
【Patients and Methods 】
This was a retrospective study of 40 patients admitted to the ICU after undergoing liver transplantation from 2014 to 2016.
Our institution did not have a definite protocol for the supplementation of human albumin, but the traditional procedure was to administer albumin to ameliorate ascites without any definite index.
The data collected included the patients’ pre-, intra-, and postoperative information during the first postoperative week.
The study patients were divided into two groups: the higher albumin (HA) group (n=20) and the lower albumin (LA) group (n=20) according to serum albumin level >3 g/dL during the first postoperative week.
As the primary endpoint, the SOFA score representing organ dysfunction after liver transplantation was compared between the two groups.
The secondary endpoints were complications (ascites amount, rejection, reintubation, abdominal re-operation, thrombosis), additional treatment (dialysis, pleural effusion drainage), and length of ICU and hospital stay.
HA group
（n=20）
LA group
P value
Age
51 (40-61)
55 (51-61)
0.70
Gender（Male, %）
9（45%） 1
BMI(kg/m2)
23.4 ( )
23.3 ( )
0.69
Child Score
11 (10-12)
0.83
MELD Score
19 (14-25)
15 (13-21)
0.11
Type of liver-transplantation
Lining-donor / Brain-death
19 /1
16 / 4
0.14
HA group
（n=20）
LA group
P value
Intraoperative data
Length of anesthesia (min)
630 ( )
666 ( )
0.67
Length of surgery (min)
526 ( )
550 ( )
0.91
Blood loss (ml)
4405 ( )
5645 ( )
0.32
Urine (ml)
945 ( )
1325 ( )
0.27
Crystalloid (ml)
1800 ( )
2300 ( )
0.87
HES (ml)
1000 ( )
1100 ( )
0.78
Albumin (ml)
2250 (0-1312)
1150 (0-3638)
0.30
RBC (ml)
1960 ( )
3000 ( )
0.38
FFP (ml)
2640 ( )
2760 ( )
0.53
Platelet (ml)
200 ( )
300 ( )
0.90
Ascites (ml)
175 (0-1312)
Fluid balance (ml)
4035 ( )
2265 ( )
0.12
Discussions
Some guidelines recommended the use of albumin infusion in decompensated cirrhosis with spontaneous bacterial peritonitis, hepatorenal syndrome, large volume parecentesis and decompensated cirrhosis with complications.
we use albumin for the supplement of postoperative ascites in liver-transplantation.
But the effect of albumin infusion for liver-transplantation is unknown.
In our reserch of patients following liver transplantation, serum albumin level may not influence cumulative organ function (as measured by the SOFA score), but may preserve cardiovascular function.
HA group
（n=20）
LA group
P value
Postoperative data
Albumin 5% (ml)
6073 ( )
5655 ( )
0.27
RBC (ml)
140 (0-350)
280 (0-560)
0.87
FFP (ml)
1800 ( )
720 ( )
0.09
Platelet (ml)
300 ( )
200 (0-250)
0.10
Ascites (ml)
10715 ( )
9873 ( )
0.83
Fluid balance (ml)
-708 ( )
3147 ( )
0.06
Conclusion
The study results suggest that serum albumin level may not influence cumulative organ.
On the other hand, serum albumin level may preserve cardiovascular function in patients following liver transplantation.