In this study, we investigated the prognostic value of serum sodium and hyponatremia (<130 mEq/L) in 262 cirrhotic patients consecutively listed, 19 of which died (7%), 175 survived (67%), and 68 underwent liver transplantation (26%) during 3 months of follow-up. Hyponatremia was present in 63% of patients who died, compared to 13% of those who survived (P < .001), whereas the proportion with elevated creatinine (>1.4 mg/dL) was low and similar in both groups (10.5 vs. 3%). Prevalence of hyponatremia was higher than that of elevated serum creatinine across all model for end-stage liver disease (MELD) categories. Using logistic regression, hyponatremia and serum sodium were significant predictors of mortality with concordance statistics (c-statistics) .753 for hyponatremia, .784 for sodium, .894 for MELD, .905 for MELD plus hyponatremia (P ‫؍‬ .006 vs. MELD alone), and .908 for MELD plus serum sodium (P ‫؍‬ .026 vs. MELD alone). Risk of death across all MELD scores was higher for patients with hyponatremia than without hyponatremia. Cox regression considering data within 6 months of follow-up yielded qualitatively similar results, with hyponatremia being a significant predictor of greater mortality risk with an odds ratio of 2.65 (P ‫؍‬ .015). Each increase of 1 mEq/L of serum sodium level was associated with a decreased odds ratio of .95 (P ‫؍‬ .048). Our results indicate that hyponatremia appears to be an earlier and more sensitive marker than serum creatinine to detect renal impairment and / or circulatory dysfunction in patients with advanced cirrhosis. In conclusion, addition of serum sodium to MELD identified a subgroup of patients with poor outcome in a more efficient way than MELD alone and significantly increased the efficacy of the score to predict waitlist mortality. (Liver Transpl 2005; 11:336-343.)

One of the unresolved problems in liver transplantation is how to determine accurately the cause of the primary nonfunction that is seen in about 10% of hepatic grafts (1,2). It is often assumed that ischemic injury has occurred when the new liver does not function. Acute immunologic injury comparable to the humorally mediated hyperacute rejection of kidneys probably occurs rarely, if at all (3), but an indolent version of hyperacute hepatic rejection that is not clearly associated with demonstrable preformed antibodies can cause hemorrhagic necrosis within 1 or 2 days (4). The other most common etiology of primary nonfunction probably is intraoperative injury of the transplant when a flawed operation is performed by the recipient team (1).

Assessment of prognosis in fulminant hepatic failure (FHF) is essential for the need and appropriate timing of orthotopic liver transplantation (OLT). In this study we investigated the prognostic efficacy of King's College criteria, Clichy's criteria, Model for End-Stage Liver Disease (MELD), and Pediatric End-Stage Liver Disease (PELD) in 120 consecutive patients with FHF. Survival with medical therapy (18%), death without OLT (15%), and receipt of a liver transplant were similar in adults (n ϭ 64) and children (n ϭ 56). MELD scores were significantly higher in patients who died compared to those who survived without OLT, both in adults (38 Ϯ 7 vs. 26 Ϯ 7, P ϭ 0.0003) and children (39 Ϯ 7 vs. 23 Ϯ 6, P ϭ 0.0004). Using logistic regression analysis in this cohort of patients, concordance statistics were significantly higher for MELD (0.95) and PELD (0.99) when compared to King's College (0.74) and Clichy's criteria (0.68). When data was analyzed in a Cox model including patients receiving transplants and censoring the time from admission, the concordance statistic for MELD (0.77) and PELD (0.79) remained significantly higher than that of King's College criteria but not higher than that of Clichy's criteria. In conclusion, this study is the first to show that MELD and PELD are superior to King's College and Clichy's criteria to assess prognosis in FHF. However, because data was generated from a single center and included a rather low number of patients who survived or died without OLT, further confirmation of our findings is required. Liver Transpl 13: 822-828, 2007.

The use of a nonvascularized FoRM is a novel and simple surgical option to resolve complex abdominal wall defects in liver/intestinal/multivisceral transplant recipients when it can be covered with the recipient skin.

The AFP model could be useful in Latin-American countries to better select patients for LT in subgroups presenting with extended criteria. However, particular attention should be focused on patients with HBV.