Elevated serum sodium in recipients of liver transplantation has a substantial impact on outcomes.
Malcolm F McDonaldSpencer C BarrettTahir H MalikAdrish AnandStephanie S KeelingCaroline R ChristmannCameron R GoffNhu Thao Nguyen GalvánFasiha KanwalGeorge CholankerilJohn GossAbbas RanaPublished in: Transplant international : official journal of the European Society for Organ Transplantation (2021)
Dysnatremias are a rare but significant event in liver transplantation. While recipient pre-transplant hypernatremia has been demonstrated to increase post-transplant mortality, the degree of hypernatremia and the impact of its resolution have been less well characterized. Here, we used multivariate Cox regression with a comprehensive list of donor and recipient factors in order to conduct a robust multivariate retrospective database study of 54,311 United Network for Organ Sharing (UNOS) liver transplant patients to analyze the effect of pre-transplant serum sodium on post-transplant mortality, post-transplant length of hospitalization, and post-transplant graft survival. Mortality and graft failure increased in a stepwise fashion with increasing pre-transplant hypernatremia: 145 -150 mEq/L (HR = 1.118 and HR = 1.113), 150-155 mEq/L (HR = 1.324 and HR = 1.306), and > 155 mEq/L (HR = 1.623 and HR = 1.661). Pre-transplant hypo- and hypernatremia also increased length of post-transplant hospitalization: < 125 mEq/L (HR = 1.098), 125-130 mEq/L (HR = 1.060), 145 -150 mEq/L (HR = 1.140), and 150-155 mEq/L (HR = 1.358). Resolution of hypernatremia showed no significant difference in mortality compared with normonatremia, while unresolved hypernatremia significantly increased mortality (HR = 1.254), including a durable long-term increased mortality risk for patients with creatinine < 2 mg/dL and MELD < 25. Pre-transplant hypernatremia serves as a morbid prognostic indicator for post-transplant morbidity and mortality.
Keyphrases
- cardiovascular events
- risk factors
- end stage renal disease
- type diabetes
- healthcare
- bariatric surgery
- newly diagnosed
- cardiovascular disease
- chronic kidney disease
- emergency department
- patient reported outcomes
- adipose tissue
- single molecule
- social media
- health information
- skeletal muscle
- data analysis
- glycemic control