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Pretransplant severe hepatic encephalopathy, peritransplant sodium and post-liver transplantation morbidity and mortality



Norah A. Terrault, MD, MPH, University of California San Francisco, 513 Parnassus Ave, Box 0538, San Francisco, CA 94143, USA

Tel: +1 415 476 2777

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Hepatic encephalopathy (HE) does not enhance the prediction of model of end-stage liver disease (MELD) wait-list mortality, but its influence on post-liver transplantation (LT) morbidity and mortality is largely unknown.


To examine the association between severe pre-LT HE and peri-LT serum sodium levels as well as post-LT length of stay (LOS) and survival.


A retrospective cohort of 393 adult patients undergoing first LT for end-stage liver disease and followed for a median of 4 years post-LT was performed to evaluate the association between severe HE within the 30 days prior to LT and selected in-hospital post-LT outcomes.


Thirty-nine (10%) of the cohort had severe HE pre-LT. Patients with severe HE more frequently had Na changes of ≥15 mmol/L in the peri-LT period (P = 0.002). LOS was significantly longer for severe HE than non-severe HE patients (16 vs. 8 days, P < 0.0001) and this association was independent of MELD, presence of hepatocellular carcinoma, pre-LT nadir serum sodium and pre- to post-LT change in serum sodium. The 1-year mortality was 15% in the severe HE vs. 7% in the non-severe HE groups (HR = 2.19, P = 0.08), and this difference was attenuated by adjusting for pre-LT severe hypernatremia, but increased by adjusting for donor risk index.


Severe HE mainly affects LOS, and this association is independent of MELD. Whether the large changes in peri-LT serum Na, more frequently seen in the severe HE group, contribute to post-LT morbidity requires further study.