title: Hyponatremia impairs early posttransplantation outcome in patients with cirrhosis undergoing liver transplantation.
abstract: 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.
authors.affiliation: Liver Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Maria-Carlota
authors.initials: MC
authors.lastname: Londoño
authors.forename: Mónica
authors.initials: M
authors.lastname: Guevara
authors.forename: Antoni
authors.initials: A
authors.lastname: Rimola
authors.forename: Miquel
authors.initials: M
authors.lastname: Navasa
authors.forename: Pilar
authors.initials: P
authors.lastname: Taurà
authors.forename: Antoni
authors.initials: A
authors.lastname: Mas
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: García-Valdecasas
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: 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