title: Pretransplant severe hepatic encephalopathy, peritransplant sodium and post-liver transplantation morbidity and mortality.
abstract: BACKGROUND
  Hepatic encephalopathy (HE) does not enhance the prediction of model of end-stage liver disease (MELD) wait-list mortality, but its influence on post-liver transplantation (LT) morbidity and mortality is largely unknown.
  
  
  OBJECTIVE
  To examine the association between severe pre-LT HE and peri-LT serum sodium levels as well as post-LT length of stay (LOS) and survival.
  
  
  METHODS
  A retrospective cohort of 393 adult patients undergoing first LT for end-stage liver disease and followed for a median of 4 years post-LT was performed to evaluate the association between severe HE within the 30 days prior to LT and selected in-hospital post-LT outcomes.
  
  
  RESULTS
  Thirty-nine (10%) of the cohort had severe HE pre-LT. Patients with severe HE more frequently had Na changes of ≥15 mmol/L in the peri-LT period (P = 0.002). LOS was significantly longer for severe HE than non-severe HE patients (16 vs. 8 days, P < 0.0001) and this association was independent of MELD, presence of hepatocellular carcinoma, pre-LT nadir serum sodium and pre- to post-LT change in serum sodium. The 1-year mortality was 15% in the severe HE vs. 7% in the non-severe HE groups (HR = 2.19, P = 0.08), and this difference was attenuated by adjusting for pre-LT severe hypernatremia, but increased by adjusting for donor risk index.
  
  
  CONCLUSIONS
  Severe HE mainly affects LOS, and this association is independent of MELD. Whether the large changes in peri-LT serum Na, more frequently seen in the severe HE group, contribute to post-LT morbidity requires further study.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Brandman
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.forename: Bilal
authors.initials: B
authors.lastname: Hameed
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
mesh_terms: D002140:California / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D058625:End Stage Liver Disease; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006801:Humans; D007010:Hyponatremia; D007902:Length of Stay; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood
chemical_list: D012964:Sodium