title: Donor hypernatremia before procurement and early outcomes following pediatric liver transplantation.
abstract: The demand for transplantable organs far outweighs the supply. Recently, efforts have been made to increase the donor pool by adopting extended criteria for livers, including those from hypernatremic donors. Currently, there is no clear evidence that the use of organs from hypernatremic donors has detrimental effects on pediatric liver transplantation (LT) recipients. Our aim was to use the Scientific Registry of Transplant Recipients database to evaluate the effects of donor hypernatremia on 30-day outcomes in pediatric LT recipients. We performed an analysis of 2325 children who underwent whole or partial LT between 2005 and 2010. First, we sought to determine a donor sodium threshold for increased mortality following pediatric LT. Second, we examined rates of mortality and graft failure at 30 days after LT in patients receiving grafts from hypernatremic donors compared to patients receiving grafts from normonatremic donors. Hypernatremia was defined as a donor sodium level of ≥160 µmol/L. The primary outcome measure was mortality at 30 days after transplant. The secondary outcome measure was graft failure at 30 days after transplant. There was no threshold sodium level for increased 30-day mortality following pediatric LT. Mean recipient ages/weights, Pediatric End-Stage Liver Disease/Model for End-Stage Liver Disease scores, and mean cold and warm ischemia times were similar between the 2 study groups. There were no significant differences in mortality rates (3.9% versus 4.5%; P = 0.87) and graft failure rates (2.2% versus 1.9%; P = 1.00) in patients receiving grafts from hypernatremic donors compared to patients receiving grafts from normonatremic donors at 30 days after LT. In conclusion, donor hypernatremia just before procurement does not appear to have negative effects on mortality and graft failure rates at 30 days following pediatric LT.
authors.affiliation: Divisions of Pediatric Surgery, University Hospitals Geneva, Geneva, Switzerland.
authors.forename: Neema
authors.initials: N
authors.lastname: Kaseje
authors.affiliation: Division of Pediatrics, University Hospitals Geneva, Geneva, Switzerland.
authors.forename: Valerie
authors.initials: V
authors.lastname: McLin
authors.affiliation: Division of Surgery, University Hospitals Geneva, Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.affiliation: Division of Center for Epidemiology, University Hospitals Geneva, Geneva, Switzerland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Poncet
authors.affiliation: Divisions of Pediatric Surgery, University Hospitals Geneva, Geneva, Switzerland.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Wildhaber
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012964:Sodium / Q000097:blood*; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D012964:Sodium