Subscribe to RSS
DOI: 10.1055/s-0032-1329703
Donor Hypernatremia Influences Outcomes Following Pediatric Liver Transplantation
Publication History
18 May 2012
18 August 2012
Publication Date:
19 November 2012 (online)
![](https://www.thieme-connect.de/media/ejps/201301/lookinside/thumbnails/10.1055-s-0032-1329703-1.jpg)
Abstract
Introduction With the rising demand for liver transplantations (LTs), and the shortage of organs, extended criteria including donor hypernatremia have been adopted to increase the donor pool. Currently, there is conflicting evidence on the effect of donor hypernatremia on outcomes following LT. Our aim was to investigate differences in outcome in patients receiving grafts from hypernatremic donors compared with patients receiving grafts from normonatremic donors in the pediatric population.
Methods We retrospectively reviewed 94 pediatric patients with LTs from 1994 to 2011. We divided the patients into two groups: patients receiving organs from donors with sodium levels < 150 µmol/L, n = 67 (group 1), and patients receiving organs from donors with sodium levels ≥ 150 µmol/L, n = 27 (group 2). Using proportions and means, we analyzed patient age, sex, weight, model for end-stage liver disease (MELD) score, primary diagnosis, emergency of procedure, intraoperative transfusion volume, cold ischemia time, donor age, graft type, and postoperative graft function. Rates of mortality, rejection, early biliary, infectious, and vascular complications were calculated.
Results Mean age was 3.9 years in group 1 and 3.7 years in group 2 (p = 0.69). Mean weight and MELD scores were similar in the two study groups (16.0 vs. 15.9 and 21.2 vs. 22.0, respectively). There were no significant differences in mean cold ischemia times 6.4 versus 6.9 hours (p = 0.29), and mean intraoperative transfusion volumes 1,068.5 mL versus 1,068.8 mL (p = 0.89). There were no statistically significant differences in mortality rates (7.3 vs. 11.1%, p = 0.68). Prothrombin time (PT) at day 10 post-LT was significantly lower in group 2 (79 vs. 64, p = 0.017), and there was a higher relative risk (RR) for early thrombotic vascular complications in group 2 (RR = 2.48); however, this was not significant (p = 0.26). No significant differences in RR for rejection (0.97, p = 0.86), viral infections (1.24, p = 0.31), bacterial infections (0.86, p = 0.62), or early biliary complications (1.03, p = 1.00) were observed.
Conclusion In pediatric LT patients receiving grafts from hypernatremic donors, there are no significant increases in rates of mortality, rejection, early biliary, and infectious complications. However, there is a statistically significant lower PT at postoperative day 10 following transplantation, and a more than double RR for early thrombotic vascular complications although this was not statistically significant.
-
References
- 1 Cywinski JB, Mascha E, Miller C , et al. Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function. Liver Transpl 2008; 14 (1) 59-65
- 2 Mangus RS, Fridell JA, Vianna RM , et al. Severe hypernatremia in deceased liver donors does not impact early transplant outcome. Transplantation 2010; 90 (4) 438-443
- 3 Totsuka E, Fung U, Hakamada K , et al. Analysis of clinical variables of donors and recipients with respect to short-term graft outcome in human liver transplantation. Transplant Proc 2004; 36 (8) 2215-2218
- 4 Totsuka E, Dodson F, Urakami A , et al. Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia. Liver Transpl Surg 1999; 5 (5) 421-428
- 5 González FX, Rimola A, Grande L , et al. Predictive factors of early postoperative graft function in human liver transplantation. Hepatology 1994; 20 (3) 565-573
- 6 Figueras J, Busquets J, Grande L , et al. The deleterious effect of donor high plasma sodium and extended preservation in liver transplantation. A multivariate analysis. Transplantation 1996; 61 (3) 410-413
- 7 Briceno J, Lopez-Cillero P, Rufian S , et al. Impact of marginal quality donors on the outcome of liver transplantation. Transplant Proc 1997; 29 (1–2) 477-480
- 8 Avolio AW, Agnes S, Magalini SC, Foco M, Castagneto M. Importance of donor blood chemistry data (AST, serum sodium) in predicting liver transplant outcome. Transplant Proc 1991; 23 (5) 2451-2452