HYPOALBUMINEMIA AS AN INDEPENDENT PREDICTOR OF ACUTE RENAL INJURY AFTER LIVER TRANSPLANTATIONRamu00edrez Gonzu00e1lez M., Gu00f3mez Rojo M., MD; Gajate Martin L.; Cerro Zaballos C., Villahoz Martu00ednez J. Dept. of Anesthesiology and Intensive CareHospital Universitario Ramu00f3n y Cajal, Madrid, SpainABSTRACTBackground: Liver transplantation remains the only effective treatment for end-stage liver disease and fulminant liver failure. Throughout recent years, due to improved surgical techniques and advances in the field of perioperative management, survival rates have risen. Nevertheless, there are still serious complications which can arise both during surgery and in the postoperative period. Moreover, albumin has been found to suffer important modifications regarding both its synthesis and degradation in critical patients. Already published studies are highly controversial regarding the impact of serum albumin during the immediate postoperative period in patients undergoing liver transplantation. Goal study: To assess hypoalbuminemia as an independent predictor for the development of acute renal injury after liver transplantation. Material and methods: We carried out an analysis of liver transplantation procedures carried out between January 2011 and December 2015 in our center. All of them received the same immunosuppression therapy for protection of kidney function based on basiliximab, corticoids, mycophenolate mofetil and delayed introduction of tacrolimus and underwent the same surgical technique (Piggy back). All patients were adults over 18 years old. We analyzed the incidence of acute kidney injury (AKI) in two separate cohorts, one with plasma albumin of 3 g/dl or more (group A), and the other with plasma albumin under 3 g/dl (group B). We defined AKI according to KDIGO criteria (Increase in SCr by u22650.3 mg/dl (26.5u00b5mol/l) within 48 hours or increase in SCr to u22651.5 times baseline, which is known or presumed to have occurred within the prior 7 days or Urine volume <0.5 ml/kg/h for 6 hours)First, we carried out a raw analysis of the differences between both groups regarding all registered variables (pre, intra and postoperatively). Next the sample underwent univariate analysis to identify potentially unbalanced variables which could act as confounding factors. Finally, we used binary logistic regression with the previously established significant variables (we considered statistical significance for p<0.05 and two-tailed tests). Results: A total of 166 patients were considered, 3 of which were finally discarded due to lost values. Raw analysis showed a significant difference regarding the incidence of AKI between group A (32%) and group B (63.6%). Once univariate analysis was completed looking for confounding factors, logistic regression including significant results (surgery time, intraoperative transfusion of red blood cells (RBCs), diuretic treatment prior to transplantation and intraoperative reperfusion syndrome) showed that patients with serum albumin levels <3g/dl were at an increased risk (2.4 higher) of developing AKI in the postoperative period of liver transplantation (OR 2.4; CI 1.1-4.9; p=0.023). Conclusions: In our sample, patients with hypoalbuminemia have an increased risk of developing AKI during the postoperative period following liver transplantation. Thus, the optimization of serum albumin levels could reduce the incidence of AKI.