Background & Aims: Hyponatremia is an important predictor of early death among cirrhotic patients in the orthotopic liver transplantation (OLT) waiting list. Evidence exists that prioritizing OLT waiting list according to the MELD score combined with plasma sodium concentration might prevent pretransplantation death. However, the evolution of plasma sodium concentrations during the perioperative period of OLT is not well known. We aimed to describe the evolution of perioperative sodium concentration during OLT and its relation to perioperative neurohormonal responses.Methods: Twenty-seven consecutive cirrhotic patients who underwent OLT were prospectively included in the study over a period of 27 months. We studied the evolution of plasma sodium levels, the hemodynamics, the neurohormonal response and other biological markers during the perioperative period of OLT.Results: All patients with a hyponatremia before OLT were in the Child C group. None of the patients had acute or chronic renal impairment. Interestingly, in patients with hyponatremia, plasmatic sodium reached normal levels as soon as the injured livers were removed during surgery and the plasma sodium concentration remained within normal ranges 1 day, 7 days, as well as 6 months after surgery.Conclusions: Further investigation of rapid correction and stabilization of sodium levels after OLT, as observed in our study, would be of interest in order to fully understand the mecanisms involved in cirrhosis related hyponatremia, its prognostic value and clinical implications.

Our data are in line with studies using single direct assessment of intravascular volume 1-3 or functional assessments. 4 Single measurements preclude detection of individual changes. We have assessed such changes and demonstrate that no clinically relevant losses in total blood volume occur. We excluded patients with conditions predisposing to hypovolaemia. They include a broad range of conditions from obvious to the very subtle than occur especially in the elderly.Our findings lay the physiological basis for current goaldirected strategies of peri-operative fluid administration that explicitly preclude initial fluid loading and significantly reduce adverse outcomes. Vice versa, our data show that preventive administration of large volumes of intravenous fluids during induction of general anaesthesia to compensate for erroneously presumed fluid losses lack scientific reason.

Background & Aims Hyponatremia is an important predictor of early death among cirrhotic patients in the orthotopic liver transplantation (OLT) waiting list. Evidence exists that prioritizing OLT waiting list according to the MELD score combined with plasma sodium concentration might prevent pre transplantation death. However, the evolution of plasma sodium concentrations during the perioperative period of OLT is not well known. We aimed to describe the evolution of perioperative sodium concentration during OLT and its relation to perioperative neurohormonal responses. Methods Twenty-seven consecutive cirrhotic patients who underwent OLT were prospectively included in the study over a period of 27 months. We studied the evolution of plasma sodium levels, the hemodynamics, the neurohormonal response and other biological markers during the perioperative period of OLT. Results Among study’s population, four patients had hyponatremia before OLT, all with Child cirrhosis. In patients with hyponatremia, plasmatic sodium reached normal levels during surgery, and sodium levels remained within normal ranges 1 day, 7 days, as well as 6 months after surgery for all patients. Creatinine clearance was decreased significantly during the perioperative period, while creatinine and cystatin C levels increased significantly. Neutrophil gelatinase-associated lipocalin (NGAL) and vasopressin levels did not change significantly in this period. Plasma renin activity, concentrations of norepinephrine and brain natriuretic peptide varied significantly during the perioperative period. Conclusion In our study, plasmatic sodium concentrations among hyponatremic cirrhotic patients undergoing OLT seem to reach normal levels after OLT and remain stable six months after surgery providing more evidence for the importance of sodium levels in prioritization of liver transplant candidates. Further investigation of rapid correction and stabilization of sodium levels after OLT, as observed in our study, would be of interest in order to fully understand the mechanisms involved in cirrhosis-related hyponatremia, its prognostic value and clinical implications.

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