肾移植术后中远期，由免疫或者非免疫因素导致的慢性移植肾损伤(CAI)逐渐出现。40%~80%的受者出现以大量蛋白尿为主要临床表现的移植肾功能不全，伴或者不伴血清肌酐升高。随着病程迁延，低蛋白血症逐渐出现。在CAI的对因治疗过程中，长期低蛋白血症导致感染、心血管疾病、CNI肾毒性、血栓性疾病、贫血以及衰弱等并发症风险明显增加。目前，相关诊疗指南中静脉补充白蛋白和针对改善容量负荷的超滤/透析指征较为严格。临床实践表明，对现有低蛋白血症诊疗模式进行适当调整，基于白蛋白水平、临床表现及移植肾功能等多维指标建立风险分层，整合药物优化、白蛋白补充与超滤/透析等措施，制定个体化白蛋白管理策略，有助于维持肾移植受者长期存活。对肾移植术后低蛋白血症受者进行分层诊疗和多学科综合治疗，有望减少并发症风险，改善临床预后。

In the medium-to-long term following kidney transplantation, chronic allograft injury (CAI) induced by immunological or non-immunological factors gradually develops. Approximately 40%-80% of patients present with transplant renal dysfunction characterized by severe proteinuria as the primary clinical manifestation, with or without elevated serum creatinine. As the disease progresses, hypoalbuminemia gradually emerges. During the etiological treatment of CAI, persistent hypoalbuminemia significantly increases the risk of complications, including infections, cardiovascular diseases, calcineurin inhibitor nephrotoxicity, thrombotic diseases, anemia, and frailty. Current clinical practice guidelines maintain relatively strict indications for intravenous albumin supplementation and ultrafiltration/dialysis for volume management. Clinical practice demonstrates that appropriately modifying current management paradigms for hypoalbuminemia—by establishing risk stratification based on multidimensional indicators such as albumin levels, clinical manifestations, and allograft function, and integrating measures such as medication optimization, albumin supplementation, and ultrafiltration/dialysis—to formulate individualized albumin management strategies may help sustain long-term graft and patient survival. Implementing stratified diagnosis and treatment along with multidisciplinary team for kidney transplant recipients with hypoalbuminemia holds promise for reducing complication risks and improving clinical outcomes.