Pretransplant Hyponatremia Could Be Associated With a Poor Prognosis After Liver Transplantation

• Published in: Transplantation proceedings Vol. 42; no. 10; pp. 4119 - 4122
• Main Authors: Boin, I.F.S.F, Capel, C, Ataide, E.C, Cardoso, A.R, Caruy, C.A, Stucchi, R.S.B
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.12.2010; Elsevier
• Subjects: Adult; Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Hyponatremia - physiopathology; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Preoperative Period; Prognosis; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Tissue, organ and graft immunology; Hydroelectrolytic balance disorder; Hyponatremia; Prognosis; Digestive system; Liver; Homotransplantation; Inorganic element; Medicine; Metabolic disorder; Association; Treatment; Sodium; Surgery; Graft; Preoperative; Liver transplantation
• DOI: 10.1016/j.transproceed.2010.10.019
• ISSN: 0041-1345

Abstract Introduction Predicting the prognosis of hepatic cirrhosis is the most accurate method to achieve a fair allocation among the liver transplant waiting list thereby reducing overall mortality rates. Aim To study the survival rates of recipients who undergo liver transplantation in association with hyponatremia rates. Methods This retrospective study used a prospectively collected database. The characteristics of liver donors and recipients were: age (years), Model for End-stage Liver Disease (MELD), MELD Na score, recipient body mass index (kg/m2 ), warm ischemia time (minutes), cold ischemia time (minutes), intensive care unit time (days), hemocomponents transfused, recipient glycemia (mg/dL) and serum sodium (mEq/L), Child-Pugh-Turcotte classification (points), and survival time (months). We analyzed all 318 consecutive liver transplantations from February 1994 to May 2010 divided into two groups: A (Na > 130 mEq/L) and B (Na ≤ 130 mEq/L). The Kaplan-Meier method was used to evaluate survival rate and the Cox regression test to identify predictive factors. Results Hyponatremic patients displayed shorter survival ( P = .04). The Cox regression for survival time showed that patients with low serum sodium values (group B) had: Child-Pugh scores with 1.13% plus risk of death for each point; cold ischemia time with 1.001% less risk of death for each minute; glycemia with 0.6% for each mg/dL; 0.66% use of cell-saver; plus a risk of death for each 100 mL plus 1.02% risk of death for each year of donor age. Conclusion Hyponatremic cirrhotic patients show more advanced stages of disease compared to normonatremic cirrhotics. They usually display metabolic or cirrhotic decompensation and comorbidities. When these symptoms were associated with the use of extended criteria donors, increased cold ischemia time, and intraoperative bleeding, we observed lower survival rates.