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Liver Failure/Cirrhosis/Portal Hypertension
Impact of pretransplant hyponatremia on outcome following liver transplantation†
Article first published online: 23 JAN 2009
Copyright © 2009 American Association for the Study of Liver Diseases
Volume 49, Issue 5, pages 1610–1615, May 2009
How to Cite
Yun, B. C., Kim, W. R., Benson, J. T., Biggins, S. W., Therneau, T. M., Kremers, W. K., Rosen, C. B. and Klintmalm, G. B. (2009), Impact of pretransplant hyponatremia on outcome following liver transplantation. Hepatology, 49: 1610–1615. doi: 10.1002/hep.22846
Potential conflict of interest: Nothing to report.
- Issue published online: 27 APR 2009
- Article first published online: 23 JAN 2009
- Accepted manuscript online: 23 JAN 2009 12:00AM EST
- Manuscript Accepted: 9 JAN 2009
- Manuscript Received: 5 SEP 2008
- National Institute of Diabetes, Digestive and Kidney Disease. Grant Number: DK-34238
Hyponatremia is associated with reduced survival in patients with cirrhosis awaiting orthotopic liver transplantation (OLT). However, data are sparse regarding the impact of hyponatremia on outcome following OLT. We investigated the effect of hyponatremia at the time of OLT on mortality and morbidity following the procedure. The study included 2,175 primary OLT recipients between 1990 and 2000. Serum sodium concentrations obtained immediately prior to OLT were correlated with subsequent survival using proportional hazards analysis. Morbidity associated with hyponatremia was assessed, including length of hospitalization, length of intensive care unit (ICU) admission, and occurrence of central pontine myelinolysis (CPM). Out of 2,175 subjects, 1,495 (68.7%) had normal serum sodium (>135 mEq/L) at OLT, whereas mild hyponatremia (125-134 mEq/L) was present in 615 (28.3%) and severe hyponatremia (<125 mEq/L) in 65 (3.0%). Serum sodium had no impact on survival up to 90 days after OLT (multivariate hazard ratio = 1.00, P = 0.99). Patients with severe hyponatremia tended to have a longer stay in the ICU (median = 4.5 days) and hospital (17.0 days) compared to normonatremic recipients (median ICU stay = 3.0 days, hospital stay = 14.0 days; P = 0.02 and 0.08, respectively). There were 10 subjects that developed CPM, with an overall incidence of 0.5%. Although infrequent, the incidence of CPM did correlate with serum sodium levels (P < 0.01). Conclusion: Pre-OLT serum sodium does not have a statistically significant impact on survival following OLT. The incidence of CPM correlates with hyponatremia, although its overall incidence is low. Incorporation of serum sodium in organ allocation may not adversely affect the overall post-OLT outcome. (HEPATOLOGY 2009;49:1610–1615.)