Ascites and serum sodium are markers of increased waiting list mortality in children with chronic liver failure

Authors

  • Renata Pugliese,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Eduardo A. Fonseca,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Gilda Porta,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Vera Danesi,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Teresa Guimaraes,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Adriana Porta,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Irene K. Miura,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Cristian Borges,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Helry Candido,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Marcel Benavides,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Flavia H. Feier,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Andre Godoy,

    1. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Rita Antonelli Cardoso,

    1. STATS Estatistica em Ciências e Negócios
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  • Mario Kondo,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
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  • Paulo Chapchap,

    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
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  • Joao Seda Neto

    Corresponding author
    1. Hepatology and Liver Transplantation, Sirio-Libanês Hospital and Menino Jesus Hospital
    2. Hepatology and Liver Transplantation, AC Camargo Hospital
    • Address reprint requests to: Joao Seda Neto, M.D., Ph.D., Rua Barata Ribeiro, 414, cj 65, Bela Vista, Sao Paulo, Brazil, 01308000. E-mail: joaoseda@gmail.com; fax: +55-11-32310900.

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  • See Editorial on Page 1678

    Potential conflict of interest: Nothing to report.

Abstract

Ascites is the most common complication of cirrhosis and in adults it is associated with 50% mortality at 5 years if patients do not receive a liver transplant. The occurrence of hyponatremia in these patients has been associated with increased mortality on the waiting list. The importance of serum sodium levels and the presence of ascites in the pediatric setting remain to be clarified. A retrospective analysis of pediatric patients with cirrhosis on the transplant list was carried out between October 2000 and February 2012. The primary objective of this study was to evaluate the association of pretransplant variables with mortality within 90 days following the inclusion of patients on the waiting list. In all, 522 patients were included in the study; 345 (66%) patients were under 1 year of age; 208 (40%) of the children presented ascites. A multivariate Cox proportional hazards analysis was conducted and total bilirubin (P < 0.001, hazard ratio [HR] = 2.09, 95% confidence interval [CI] = 1.35-3.21), international normalized ratio (INR) (P < 0.001, HR = 9.83, 95% CI = 4.51-21.45), serum sodium levels (P = 0.03, HR = 0.96, 95% CI = 0.92-0.99), ascites (P = 0.001, HR = 2.59, 95% CI = 1.44-4.64), and categorized age (0-1 versus ≥1 year old) (P = 0.025, HR = 2.33, 95% CI = 1.11-4.86) were independently associated with risk of death in 90 days. Malnutrition (Z score height/age, weight/age) and serum albumin (pediatric endstage liver disease [PELD] formula) were not included in the final model. Conclusion: The presence of ascites and serum sodium levels are important variables associated with decreased patient survival while candidates wait for a liver graft. Multicenter studies are necessary to validate these findings in order to improve current allocation policies based on the PELD score. (Hepatology 2014;59:1964–1971)

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