# Impact of Intraoperative Albumin Use During Lung Transplantation on Primary Graft Dysfunction

## TL;DR

This study examines whether using albumin during lung transplants reduces primary graft dysfunction and other complications, finding limited benefits.

## Contribution

The study introduces a corrected albumin proportion metric to evaluate albumin's impact on transplant outcomes.

## Key findings

- Higher albumin proportion reduced total intravenous fluid use.
- Total fluid volume correlated with increased 72-hour PGD risk.
- Albumin use did not independently improve PGD or short-term outcomes.

## Abstract

Background: Primary graft dysfunction (PGD) is the leading cause of early mortality after lung transplantation. Albumin is commonly used during lung transplantation to maintain intravascular volume while minimizing total intravenous fluid administration, given the established association between larger intravenous fluid and PGD. However, the direct impact of albumin on PGD remains unclear. Methods: We conducted a single-center retrospective cohort study of lung transplant recipients between 2018 and 2023. We calculated the corrected albumin proportion (cAP), representing the ratio of albumin to total intravenous fluid administered. We analyzed associations between cAP and PGD at 24, 48, and 72 h, as well as secondary outcomes including total fluid administration, 30-day acute kidney injury, mortality, and ICU length of stay. Results: A total of 190 patients were included in this study. A higher cAP was associated with lower total intravenous fluid administration (r = −0.15, p = 0.03), whereas a higher total intravenous fluid administration was associated with higher PGD at 72 h (OR 1.02, 95% CI 1.00–1.03, p = 0.04). However, cAP was not independently associated with PGD or other short-term outcomes. Conclusions: Intraoperative albumin use modestly reduced total intravenous fluid administration but was not independently associated with significant reductions in PGD or improvements in other short-term outcomes.