title: Short-Term, Low-Dose Use of Tolvaptan as a Bridge Therapy to Expedite Liver Transplant for Severe Hyponatremic, Cirrhotic Patients With High Model for End-Stage Liver Disease Scores.
abstract: For patients on liver transplant waiting lists, hyponatremia is associated with increased mortality before transplant and complications during the early posttransplant period. Conventional therapies, such as fluid restriction or hypertonic saline infusion, are of limited value. We describe 2 patients with high Model for End-Stage Liver Disease scores (> 30) who were referred to our unit for expedited liver transplant. While on waiting lists, these patients developed severe hyponatremia (< 125 mEq/L) that was refractory to conventional therapies. Low-dose, short-term tolvaptan therapy (15 mg/d for 5 d) was then administered, as a bridge therapy to transplant, resulting in prompt restoration of serum sodium levels without any major clinical event. One patient died a few days later as no suitable grafts were available. The other received a liver transplant, and the outcome was uneventful. In conclusion, our report demonstrates that a short-term, low-dose tolvaptan-based strategy promptly resolves hyponatremia in patients who are on expedited waiting lists for liver transplant, allowing surgery with improved sodium levels and possibly limiting peritransplant complications.
authors.affiliation: From the Hepatology Unit, Department of Medicine, Policlinico Universitario Tor Vergata, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Lenci
authors.forename: Martina
authors.initials: M
authors.lastname: Milana
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
authors.forename: Leonardo
authors.initials: L
authors.lastname: Baiocchi
mesh_terms: D065092:Antidiuretic Hormone Receptor Antagonists / Q000008:administration & dosage*; D001552:Benzazepines / Q000008:administration & dosage*; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D017809:Fatal Outcome; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D000077602:Tolvaptan; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan