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. 2014 Jun;20(6):687-97.
doi: 10.1002/lt.23860.

Effect of the pretransplant serum sodium concentration on outcomes following liver transplantation

Michael D Leise  1 , Byung Cheol Yun, Joseph J Larson, Joanne T Benson, Ju Dong Yang, Terry M Therneau, Charles B Rosen, Julie K Heimbach, Scott W Biggins, W Ray Kim
Affiliations

Effect of the pretransplant serum sodium concentration on outcomes following liver transplantation

Michael D Leise et al. Liver Transpl. 2014 Jun.

Abstract

Hyponatremia is associated with an increased risk of mortality on the liver transplantation (LT) waiting list. Although the incorporation of the serum sodium (Na) level into the Model for End-Stage Liver Disease score may reduce wait-list mortality, concerns remain about a potential association between pre-LT hyponatremia and decreased post-LT survival. Furthermore, the relationship between pre-LT hypernatremia and post-LT survival remains unexplored. The purpose of this study was to investigate the impact of the entire spectrum of pre-LT serum Na levels on post-LT outcomes. We identified 19,537 patients from 2003 to 2010 for whom serum Na levels immediately before LT were available. The patients were divided into 3 groups [hyponatremic (Na ≤ 130 mEq/L), normonatremic (Na = 131-145 mEq/L), and hypernatremic (Na > 145 mEq/L)], and their post-LT outcomes were compared. There was no difference in in-hospital mortality or 90-day survival between patients with hyponatremia and patients with normonatremia. A fraction of the patients (2.4%) had hypernatremia, which was associated with increased in-hospital mortality (11.2% versus 4.2%, P < 0.001) and diminished 90-day survival (86.4% versus 94.0.%, P < 0.001). After adjustments for important clinical variables, the association of pre-LT hypernatremia with posttransplant mortality remained significant with a hazard ratio of 1.13 for each unit increase in the Na level > 145 mEq/L (P < 0.001). The duration of the hospitalization after LT was significantly longer for hypernatremic patients (P < 0.001). In conclusion, hyponatremia per se does not affect post-LT survival. Pre-LT hypernatremia is a highly significant risk factor for post-LT mortality.

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Figures

Figure 1
Figure 1
Kaplan-Meier curve compares patient survival after LTx by the serum sodium level
Figure 2
Figure 2
Kaplan-Meier curve compares patient survival after LTx by mild (Na 125–130), moderate (121–124), and severe hyponatremia (Na < 120) compared to normonatremia and hyponatremia
Figure 3
Figure 3
Figure 3a. Association between serum sodium at LTx and post-LTx mortality, after adjusting for MELD score. FU=follow-up Figure 3b. Association between serum sodium at LTx and post-LTx mortality, after adjustment for age, sex, gender, diagnosis, MELD, hepatic encephalopathy, ascites, dialysis, and life support. FU=follow-up
Figure 3
Figure 3
Figure 3a. Association between serum sodium at LTx and post-LTx mortality, after adjusting for MELD score. FU=follow-up Figure 3b. Association between serum sodium at LTx and post-LTx mortality, after adjustment for age, sex, gender, diagnosis, MELD, hepatic encephalopathy, ascites, dialysis, and life support. FU=follow-up
Figure 4
Figure 4
Effect of excess sodium (number of points in excess of serum sodium of 145 mEq/L) with various adjustors from cox model* of 3 month survival after liver transplantation
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