title: Effect of the pretransplant serum sodium concentration on outcomes following liver transplantation.
abstract: Hyponatremia is associated with an increased risk of mortality on the liver transplantation (LT) waiting list. Although the incorporation of the serum sodium (Na) level into the Model for End-Stage Liver Disease score may reduce wait-list mortality, concerns remain about a potential association between pre-LT hyponatremia and decreased post-LT survival. Furthermore, the relationship between pre-LT hypernatremia and post-LT survival remains unexplored. The purpose of this study was to investigate the impact of the entire spectrum of pre-LT serum Na levels on post-LT outcomes. We identified 19,537 patients from 2003 to 2010 for whom serum Na levels immediately before LT were available. The patients were divided into 3 groups [hyponatremic (Na ≤ 130 mEq/L), normonatremic (Na = 131-145 mEq/L), and hypernatremic (Na > 145 mEq/L)], and their post-LT outcomes were compared. There was no difference in in-hospital mortality or 90-day survival between patients with hyponatremia and patients with normonatremia. A fraction of the patients (2.4%) had hypernatremia, which was associated with increased in-hospital mortality (11.2% versus 4.2%, P < 0.001) and diminished 90-day survival (86.4% versus 94.0.%, P < 0.001). After adjustments for important clinical variables, the association of pre-LT hypernatremia with posttransplant mortality remained significant with a hazard ratio of 1.13 for each unit increase in the Na level > 145 mEq/L (P < 0.001). The duration of the hospitalization after LT was significantly longer for hypernatremic patients (P < 0.001). In conclusion, hyponatremia per se does not affect post-LT survival. Pre-LT hypernatremia is a highly significant risk factor for post-LT mortality.
authors.affiliation: William J. von Leibig Transplant Center, Mayo Clinic, Rochester, MN, Mayo Clinic, Rochester, MN.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Leise
authors.forename: Byung Cheol
authors.initials: BC
authors.lastname: Yun
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Larson
authors.forename: Joanne T
authors.initials: JT
authors.lastname: Benson
authors.forename: Ju Dong
authors.initials: JD
authors.lastname: Yang
authors.forename: Terry M
authors.initials: TM
authors.lastname: Therneau
authors.forename: Charles B
authors.initials: CB
authors.lastname: Rosen
authors.forename: Julie K
authors.initials: JK
authors.lastname: Heimbach
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.forename: W Ray
authors.initials: WR
authors.lastname: Kim
mesh_terms: D015415:Biomarkers / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D007010:Hyponatremia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D017093:Liver Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D012964:Sodium