Albumin kinetics in patients with chronic thoracic duct fistulas

In a group of patients with thoracic duct fistulas (TDF) undergoing lymphocyte depletion in preparation for renal transplantation, hypoalbuminemia developed despite replacement of all lymph. Albumin kinetics were measured in ten of these patients and compared with eight similar patients treated in a home dialysis program and seven normal control subjects. Albumin concentration averaged 2.7 Gm. percent in the TDF group compared to 4.0 Gm. percent in the other two groups. The total exchangeable albumin was also reduced in the TDF group when compared to the home dialysis group. An increased catabolic rate as measured by a shortened albumin half-life and accelerated albumin turnover rate accounted for the hypoalbuminemia. It is suggested that the increased catabolism is due to an increased intestinal loss resulting from partial lymphatic obstruction from the thoracic duct cannula. Six weeks following discontinuation of the TDF, the serum albumin concentration returned to normal level.