Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation.
OBJECTIVE
Hyponatremia is associated with reduced survival in patients with cirrhosis awaiting liver transplantation. However, it is not known whether hyponatremia also represents a risk factor of poor outcome after transplantation. We aimed to assess the effects of hyponatremia at the time of transplantation on posttransplantation outcome in patients with cirrhosis.


METHODS
Two-hundred forty-one consecutive patients with cirrhosis submitted to liver transplantation during a 4-year period (January 2000-December 2003) were included in the study. The main end point was survival at 3 months after transplantation. Secondary end points were complications within the first month after transplantation.


RESULTS
Patients with hyponatremia (serum sodium lower than 130 mEq/L) had a greater incidence of neurologic disorders, renal failure, and infectious complications than patients without hyponatremia (odds ratio; 4.6, 3.4 and 2.7, respectively) within the first month after transplantation. By contrast, hyponatremia was not associated with an increased incidence of severe intra-abdominal bleeding, acute rejection, or vascular and biliary complications. Hyponatremia was an independent predictive factor of early posttransplantation survival. Three-month survival of patients with hyponatremia was 84% compared with 95% of patients without hyponatremia (P < .05). Survival was similar after 3 months.


CONCLUSIONS
In patients with cirrhosis, the presence of hyponatremia is associated with a high rate of neurologic disorders, infectious complications, and renal failure during the first month after transplantation and reduced 3-month survival. In cirrhosis, hyponatremia should be considered not only a risk factor of death before transplantation but also a risk factor of impaired early posttransplantation outcome.
Londoño
Maria-Carlota
MC
Liver Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Guevara
Mónica
M
Rimola
Antoni
A
Navasa
Miquel
M
Taurà
Pilar
P
Mas
Antoni
A
García-Valdecasas
Juan-Carlos
JC
Arroyo
Vicente
V
Ginès
Pere
P
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000150:complications / Q000209:etiology*; D007239:Infections / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000097:blood* / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome