Hyponatremia Impairs Early Posttransplantation Outcome in Patients With Cirrhosis Undergoing Liver Transplantation

Londoño, María-Carlota; Guevara, Mónica; Rimola, Antoni; Navasa, Miquel; Taurà, Pilar; Mas, Antoni; García-Valdecasas, J.C.; Arroyo, Vicente; Ginès, Pere

doi:10.1053/j.gastro.2006.02.017

Cited by 174 publications

(178 citation statements)

References 29 publications

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“…Foi definido como hiponatremia a concentração de sódio sérico igual ou inferior a 130 mEq/L, de acordo com a classificação do Clube Internacional de Ascite (32) .…”

Section: E) Hiponatremiaunclassified

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

Boin

Leonardi

Udo

et al. 2008

Arq. Gastroenterol.

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RESUMO -Racional -Utiliza-se o escore MELD (Model End-Stage Liver Disease) para o prognóstico da mortalidade em lista de espera para transplante de fígado e, em alguns estudos, para predição da sobrevida pós-operatória a longo prazo. Objetivo -Verificar a aplicação do escore MELD como predição da sobrevida após o transplante. Métodos -Por intermédio de dados coletados prospectivamente efetuou-se um estudo de coorte longitudinal retrospectivo em 232 pacientes. Excluíram-se os retransplantes, insuficiência hepática aguda, crianças e enxertos duplos ou reduzidos. Avaliaram-se os dados dos doadores: idade, sexo, peso, creatinina, bilirrubina, sódio, aspartato aminotransferase, antecedentes pessoais, causa da morte, presença de esteatose, número de critérios expandidos do doador e índice de risco do doador. Em relação aos receptores, analisaram-se as variáveis: sexo, idade, peso, doença hepática, pontos de Child-Turcotte-Pugh, escore MELD, depuração de creatinina, sódio, tempos de isquemia e de hospitalização, quantidade de hemoderivados transfundidos, presença e grau de disfunção do enxerto. A análise estatística foi efetuada usando-se a análise de regressão univariada e/ou múltipla, estatística 'c', teste exato de Fisher, método de Kaplan-Meier (teste log-rank) para sobrevida, e análise de regressão de Cox para risco de óbito ajustado para as condições clínicas. Resultados -O ponto de corte MELD para sobrevida foi 20 e de Child-Turcotte-Pugh foi 11,5. Para escore MELD maior ou igual a 20, os fatores preditivos de sobrevida foram: volume de sangue transfundido, disfunção do enxerto e o sódio do doador. Para os hiponatrêmicos os fatores preditivos de sobrevida foram: volume de sangue transfundido, disfunção do enxerto e sódio do doador. A sobrevida estimada para pacientes com escore MELD ≥25 foi menor ao final de 12 meses (68,86% vs 39,13%). A sobrevida estimada para os pacientes sem hiponatremia foi maior (65,16% vs 44,44%). A sobrevida aos 5 e 10 anos também seguiu o mesmo padrão. O uso de doadores limítrofes não alterou a sobrevida, mas quando se utilizou o índice de risco do doador observou-se que a sobrevida foi maior para pacientes com índice de risco do doador menor que 1,7 (63,62% vs 53,70%). A associação deste índice com o escore MELD não mostrou diferença estatística em relação à sobrevida. Observou-se que a falência e disfunção do enxerto foram associadas ao número crescente de critérios expandidos do doador. Os receptores de doadores maiores de 50 anos tiveram menor sobrevida (65,58% vs 38,40%) e o escore delta-MELD não discriminou a sobrevida. Conclusão -A sobrevida dos receptores a curto e longo prazo é associada a escores MELD acima de 25, ao volume de sangue transfundido, à disfunção do enxerto, à hiponatremia, à idade do doador acima de 50 anos e àqueles doadores com índice de risco do doador acima de 1,7. DESCRITORES -Transplante de fígado. Sobrevida. Doadores de tecidos. Índices de gravidade de doenças. INTRODUÇÃOO transplante de fígado vem sendo usado como terapia para doenças hepáticas terminais ...

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“…Foi definido como hiponatremia a concentração de sódio sérico igual ou inferior a 130 mEq/L, de acordo com a classificação do Clube Internacional de Ascite (32) .…”

Section: E) Hiponatremiaunclassified

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

Boin

Leonardi

Udo

et al. 2008

Arq. Gastroenterol.

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“…However, the impact of pre-transplantation hyponatremia on outcomes following liver transplantation is still controversial. It was reported that patients with hyponatremia had higher 90-day mortality after liver transplantation (Londono et al 2006). In contrast, there have been several studies indicating that pre-transplant serum sodium concentrations do not influence survival outcomes following liver transplantation Hackworth et al 2009;Neto et al 2012).…”

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confidence: 99%

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Lee

et al. 2013

Tohoku J. Exp. Med.

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Hyponatremia is prevalent before liver transplantation and generally corrected immediately after transplantation. However, the clinical significance of correction rate of hyponatremia is not well investigated. The prognostic impact of pre-transplant serum sodium concentrations and post-transplant correction rate of hyponatremia were assessed. A total of 512 patients who received orthotopic liver transplants were enrolled. The correction rate of hyponatremia (delta sodium, ΔNa) was calculated based on the data collected during the first 48 hours following liver transplantation. Outcomes, including in-hospital mortality, delirium, neurological complications, acute kidney injury, and infections, were compared according to the serum sodium levels (sNa < 125, 125-135, and ≥ 135 mmol/L), and the risk factors for in-hospital mortality and neurological complications were analyzed using multivariate logistic regression methods. Patients with severe hyponatremia (sNa < 125 mmol/L) had higher rates of in-hospital mortality (9.6%, P = 0.010), delirium (54.8%, P = 0.003), neurological complications (24.7%, P = 0.003), and acute kidney injury (57.5%, P = 0.005). In multivariate analysis, serum sodium levels (OR = 0.975, P = 0.402) and delta sodium (OR = 1.097, P = 0.066) were not independent risk factors for in-hospital mortality. However, delta sodium (OR = 1.093, P = 0.003) and fast correction rate of hyponatremia (ΔNa ≥ 12 mmol/ L/24h, OR = 3.397, P = 0.023) were significantly associated with post-transplant neurological complications. Pre-transplantation hyponatremia was not independently associated with clinical outcomes. However, rapid correction of hyponatremia is an independent risk factor for the development of post-transplant neurological complications.

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“…4 Only one study has specifically evaluated the influence of recipient hyponatremia on survival at 3 months after OLT. 5 In that particular study, hyponatremic recipients had a higher rate of neurologic disorders, infectious complications, and renal failure during the first month following OLT, as well as a significantly reduced 3-month survival. Although Londono et al focused on 3-month survival and secondary outcomes (for example, neurologic disorders, infectious complications, and renal failure), 5 our study evaluated the relationship of hyponatremia to immediate postoperative indicators of graft function (AST, ALT, and total bilirubin), LOICUS and LOHS, and recipient 30-day and overall mortality.…”

Section: Discussionmentioning

confidence: 83%

“…In fact, allograft function from donors whose serum sodium was corrected to levels below 155 mEq/mL was comparable to those organs taken from normonatremic donors. 1 On the other hand, in the study by Londono et al, 5 the authors showed that recipient hyponatremia (serum sodium Ͻ 130 mEq/mL) reduced 3-month survival following OLT. From these observations, one can infer that both the donor sodium level at the time of organ procurement and the recipient serum sodium level at the time of transplantation can significantly impact post-OLT outcomes.…”

Section: Discussionmentioning

confidence: 98%

Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function

et al. 2007

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Previous studies have shown that donor hypernatremia and possibly recipient hyponatremia negatively impact graft function after orthotopic liver transplant (OLT). The purpose of this retrospective investigation was to determine whether measured differences in serum sodium values between cadaveric donors and OLT recipients (⌬Na ϩ ) influence immediate postoperative allograft function and short-term patient outcomes. Two hundred and fifty patients that underwent OLT from January 2001 to December 2005 were included in this study. The ⌬Na ϩ for each donor recipient pair was correlated with standard postoperative liver function tests as well as recipient length of intensive care unit stay (LOICUS), length of hospital stay (LOHS) and recipient survival. The relationship between donor hypernatremia (serum sodium Ն 155 mEq/mL), recipient hyponatremia (serum sodium level Յ 130 mEq/mL), and postoperative outcomes were analyzed as well. Adjustments were made for baseline potential confounders, including model for end-stage liver disease (MELD) score, preservation solution used (HTK vs. UW), recipient and donor demographics and cold ischemia time (CIT). ⌬Na ϩ as well as donor hypernatremia and recipient hyponatremia were not found to be associated with immediate postoperative allograft function, intraoperative blood product usage, LOICUS, LOHS or short-term patient survival. However, both the preoperative MELD score and HTK preservation solution used were significantly associated with several patient outcomes. A higher MELD score was associated with both increased red blood cell (RBC) (P Ͻ 0.001) and fresh frozen plasma (FFP) usage (P ϭ 0.002), elevated postoperative total bilirubin levels (P Ͻ 0.001), increased LOHS (P ϭ 0.04), and a higher 30-day post transplant mortality (P ϭ 0.02). The use of HTK preservation solution was associated with higher mean postoperative aspartate aminotransferase levels (P ϭ 0.02) and decreased mean RBC (P Ͻ 0.001) and FFP usage (P ϭ 0.009) compared to UW preservation solution use. Liver Transpl 14: 59-65, 2008.

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Hyponatremia Impairs Early Posttransplantation Outcome in Patients With Cirrhosis Undergoing Liver Transplantation

Cited by 174 publications

References 29 publications

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function

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