Intraoperative hyponatremia is an independent predictor of one-year mortality after liver transplantation

Abstract

Preoperative hyponatremia is associated with an increased risk of mortality on the liver transplantation (LT) waiting list. We sought to investigate the impact of pre- and intraoperative serum sodium levels on the one-year mortality after LT. We identified 1,164 patients for whom preoperative and intraoperative serum sodium levels were available. Cox regression analysis with multivariable adjustment was performed for one-year mortality. A propensity score matching analysis was performed for preoperative and intraoperative serum sodium groups to compare one-year survival. The cutoff of sodium level with minimal p-value was 130 mEq/L for both preoperative and intraoperative sodium. Intraoperative hyponatremia was an independent predictor of one-year mortality in the multivariable Cox regression analysis, while preoperative hyponatremia was not. Kaplan-Meier curve showed that there was a significant difference in the one-year mortality between preoperative and intraoperative serum sodium groups. However, after propensity score matching, there was no difference in the one-year mortality among the preoperative sodium groups, while there was a significant difference among the intraoperative sodium groups. Intraoperative hyponatremia defined by mean sodium <130 mEq/L was independently associated with a significantly high one-year mortality. Mean intraoperative serum sodium levels may be a better prognostic predictor than preoperative serum sodium levels.

Figure 1

Kaplan-Meier survival curve analysis according to preoperative serum sodium groups (Na < 130 mEq/L and 130 ≤ Na ≤ 145 mEq/L) before and after propensity score matching.

Figure 2

Kaplan-Meier survival curve analysis according to intraoperative serum sodium groups (Na < 130 mEq/L and 130 ≤ Na ≤ 145 mEq/L) before and after propensity score matching.