Human albümin replasmanının karaciğer alıcılarında serum albümin düzeyine etkisi

Amaç: Karaciğer transplant hastalarında düşük serum albumin düzeylerinin kötü prognoz belirtisi olduğu ve bu hastalarda erken postoperatif dönemde ciddi hipoalbüminemi gelişebileceği bildirilmiştir. Yoğun bakımımızda serum -1 albumin düzeyi 3.0 g.dL altında belirlenen karaciğer alıcılarına rutin olarak human albumin replasmanı uygulamaktadır. Çalışmamızın amacı karaciğer transplantasyonu uygulanan hastalarda postoperatif devrede uygulanan albumin replasmanı stratejisinin retrospektif olarak değerlendirilmesidir. Gereç ve Yöntem: 81 karaciğer alıcısı 2 gruba ayrıldı. Albumin grubunu [Alb(+) grubu, n=57] serum albumin düzeyi 3.0 g dL-1 üzerine yükselene kadar % 20 human albumin replasmanı uygulanan hastalar oluşturdu. Diğer grubu [Alb(–) grubu, n=24] ise yatış süresince albumin replasmanı uygulanmayan hastalar yer aldı. -1 Bulgular: Alb(+) grubunda yatıştaki ortalama albumin düzeyi 2.5±0.4 g.dL , taburcu olurken ortalama albumin düzeyi -1 2.7±0.6 g.dL olarak belirlendi (p= 0.075). Elli yedi hastada uygulanan ortalama albumin miktarı 239.9±206 mL olarak -1 hesaplandı. Alb(–) grubunda yatışta ve taburcu olurken ortalama albumin düzeyleri sırasıyla 3.4±0.4 ve 3.1±0.5 g.dL olarak belirlendi (p = 0.071). Alb(+) grubunda üç hasta, Alb(–) grubunda ise bir hasta sepsis nedeniyle öldü. Sonuç: Alb(–) grubunda serum albumin düzeyinde anlamlı azalma belirlenmedi. Alb(+) grubunda ise postoperatif -1 devrede serum albumin düzeyi 3.0 gdL altında belirlenen karaciğer alıcılarına yaklaşık olarak ortalama 240 mL % 20 albumin uygulanmasına rağmen bu hastalarda yatışta ve taburcu olurken albumin düzeyleri arasında anlamlı fark saptanmadı.

The effect of human albumin supplementation on serum albumin levels in liver recipients

Aim: Low serum level of albumin has been shown as an adverse prognostic indicator in orthotopic liver transplant (OLT) patients and they can become profoundly hypoalbuminaemic in the early postoperative period. We routinely -1 administer albumin to liver recipients having a serum albumin level less than 3.0 g.dL . Our aim was to evaluate our albumin supplementation strategy retrospectively during the postoperative period in patients undergoing OLT. Materials and Methods: Eighty one liver recipients admitted were divided into 2 groups. The albumin group [Group -1 Alb(+), n=57] received 20% albumin until serum albumin concentration increased over 3.0 g.dL . The no-albumin group [Group Alb(–), n=24] did not receive albumin. -1 -1 Results: In Group Alb(+), the admission albumin level was 2.5±0.4 g.dL and the discharge level was 2.7±0.6 g.dL (p=0.075). Average albumin supplementation in all 57 patients was 239.9±206 mL. In Group Alb(–), admission and -1 discharge albumin levels were 3.4±0.4 and 3.1±0.5 g.dL , respectively (p=0.071). Three patients in Group Alb(+) and 1 patient in Group Alb(–) died in the ICU due to sepsis. Conclusion: Albumin concentration did not decrease significantly in Group Alb(–). Despite this, we administered a -1 mean volume of approximately 240 mL 20% albumin to liver recipients who had a serum level of less than 3.0 g.dL during the postoperative period. Serum albumin concentration did not show a significant difference between admission and discharge levels.

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