Impact of preoperative serum sodium concentration in living donor liver transplantation.
OBJECTIVE
The importance of hyponatremia in deceased donor liver transplantation (DDLT) has been recently discussed frequently. However, its impact on the outcomes in living donor liver transplantation (LDLT) has not yet been elucidated. The current study was designed to demonstrate the impact of pre-transplant sodium concentration on postoperative clinical outcomes.


METHODS
One hundred and thirty-four patients who underwent LDLT for end-stage liver diseases were examined to evaluate the significance of pre-transplant hyponatremia (Na < or = 130 mEq/L) on the short-term clinical outcomes and the efficacy of the Model for End-Stage Liver Disease and serum sodium (MELD-Na) score using the sodium concentration and original MELD score.


RESULTS
The preoperative sodium and MELD score for all patients were 133.9 mEq/L (range: 109-142) and 16.2 (range: 6-38), respectively. According to a multivariate analysis, not only the MELD score (P = 0.030) but also the sodium concentration (P = 0.005) were found to be significant predictive factors for short-term graft survival. Preoperative hyponatremia was a significant risk factor for the occurrence of sepsis (P < 0.001), renal dysfunction (P < 0.001) and encephalopathy (P = 0.026). The MELD-Na score was 19.6 (range: 6-51) and the area under the receiver-operator curve of that (c-statistics: 0.867) was higher than MELD score and sodium concentration (c-statistics: 0.820 and 0.842, respectively).


CONCLUSIONS
Preoperative hyponatremia was a significant risk for postoperative complications and short-term graft loss. The addition of sodium concentration to MELD score might therefore be an effective predictor for post-transplant short-term mortality in LDLT.
Fukuhara
Takasuke
T
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. fukut@surg2.med.kyushu-u.ac.jp
Ikegami
Toru
T
Morita
Kazutoyo
K
Umeda
Kenji
K
Ueda
Shigeru
S
Nagata
Shigeyuki
S
Sugimachi
Keishi
K
Gion
Tomonobu
T
Yoshizumi
Tomoharu
T
Soejima
Yuji
Y
Taketomi
Akinobu
A
Maehara
Yoshihiko
Y
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000209:etiology; D006085:Graft Survival; D006501:Hepatic Encephalopathy / Q000097:blood / Q000209:etiology; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000150:complications*; D007564:Japan; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology; D008107:Liver Diseases / Q000097:blood / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000209:etiology; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D012964:Sodium