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Annals of Transplantation is one of the fast-developing journals open to all scientists and fields of transplant medicine and related research. The journal is published quarterly and provides extensive coverage of the most important advances in transplantation.
Using an electronic on-line submission and peer review tracking system, Annals of Transplantation is committed to rapid review and publication. The average time... read more

Published: 2019-07-16

Prognostic Impact of Peritransplant Serum Sodium Concentrations in Liver Transplantation

Plamen Mihaylov, Shunji Nagai, Burcin Ekser, Richard Mangus, Jonathan Fridell, Chandrashekhar Kubal

(Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, USA)

Ann Transplant 2019; 24:418-425

DOI: 10.12659/AOT.914951

BACKGROUND: Serum sodium (Na) is considered to reflect the severity of liver cirrhosis. In the last few years, much effort has been made to integrate this association into prognostic models after liver transplantation. The aim of this study was to investigate the associations between peritransplant Na and neurological complications, as well as short-term survival, after liver transplantation.
MATERIAL AND METHODS: A total of 306 liver transplantations between 2012 and 2015 were evaluated. Pre- and posttransplant sodium concentrations were investigated with regard to 3-month survival and incidence of posttransplant neurological complications, along with other factors present in the operative side of the recipient and donor.
RESULTS: The 3-month survival rate was 94%. Neither hyponatremia (<130 mEq/L) nor hypernatremia (>145 mEq/L) at pretransplantion predicted 3-month survival. A large amount of intraoperative blood transfusion and a large delta Na showed a significant association with poor outcomes at 3 months. On multivariate analysis, the requirement of blood transfusion and warm ischemia time remained independent prognostic factors for 3-month mortality. Hyponatremia and a large delta Na tended to lead to the frequent development of neurological complications. These complications, secondary to rapid Na correction, were concerning and potentially led to a prolonged hospital stay and early mortality.
CONCLUSIONS: Rapid change in the sodium level might be caused by large amounts of blood transfusion products. This leads to a diminished short-term survival, as well as a higher rate of neurological complications.

Keywords: Hyponatremia, Liver Cirrhosis, Liver Transplantation

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