The Controversy of Donor Serum Sodium Levels in Heart Transplantation - A Multicenter Experience

Abstract

Background: Elevated donor serum sodium is a phenomenon often encountered in the management of brain dead donors. The clinical relevance on recipient outcome is less examined. We investigated the impact of elevated donor serum sodium levels (DSL) on outcome after heart transplantation in 1800 heart transplantations. Methods: Data was conducted in a retrospective analysis from 1989 until 2005. The transplantations were performed at three German heart transplant centers. The joined database included DSL at the time of organ procurement, recipient and donor age, ischemia time, primary graft failure and survival data. Results: Mean DSL was 147.7 ± 10.3 l/l (range 111 - 208 l/l). Recipients were divided into 4 groups with percentiles of 141, 147, and 154 l/l resulting in DSL of A: 135.8 ± 4.4, B: 143.6 ± 1.7, C: 149.7 ± 1.9, and D: 161.3 ± 7.7 l/l for the four quartiles. Primary graft failure ocurred in 2.6 % of the patients with A: 2.8 %, B: 2.8 %, C: 3.7% and D: 1.4 % (p = n.s.). Mean 5- and 10-year-survival rates were 70.9 % (57.6 %) with A: 71.1 % (53.86 %), B: 69.3 % (53.9 %), C: 72.7 % (61.0 %), D: 71.2 % (62.4 %), respectively (p = n. s.). In a multivariate analysis a significant impact on postoperative results could be revealed for recipient age (p = 0.002), ischemia time (p = 0.002) and donor age (p = 0.009). DSL were no individual risk factor in the multivariate analysis. Conclusion: There was no impact of donor serum sodium levels neither on early postoperative results, nor on long-term outcome indicating that cardiac allografts from donors with elevated sodium levels might be transplanted successfully, achieving favourable results.

Key words

Heart and lung transplantation - allocation - marginal donors

References

• 1 Smith M. Physiologic changes during brain stem death - lessons for management of the organ donor.  J Heart Lung Transplant. 2004;  23 (Suppl 9) S217-S222
• 2 Dominguez-Roldan J M, Jimenez-Gonzalez P I, Garcia-Alfaro C, Hernandez-Hazanas F, Fernandez-Hinojosa E, Bellido-Sanchez R. Electrolytic disorders, hyperosmolar states, and lactic acidosis in brain-dead patients.  Transplant Proc. 2005;  37 1987-1989
• 3 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;  61 410-413
• 4 Totsuka E, Fung U, Hakamada K, Tanaka M, Takahashi K, Nakai M, Morohashi S, Nishimura A, Ishizawa Y, Ono H, Toyoki Y, Narumi S, Sasaki M. Analysis of clinical variables of donors and recipients with respect to short-term graft outcome in human liver transplantation.  Transplant Proc. 2004;  36 2215-2218
• 5 Jawan B, Goto S, Lai C Y, de Villa V H, Luk H N, Eng H L, Chen Y S, Wang C C, Cheng Y F, Chen C L. The effect of hypernatremia on liver allografts in rats.  Anesth Analg. 2002;  95 1169-1172
• 6 Pokorny H, Langer F, Herkner H. et al . Influence of cumulative number of marginal donor criteria on primary organ dysfunction in liver recipients.  Clin Transplant. 2005;  19 532-536
• 7 Van da Walker S G. The effects of donor sodium levels on recipient liver graft function.  Journal of Transplant Coordination. 1998;  8 205-208
• 8 Totsuka E, Dodson F, Urakami A, Moras N, Ishii T, Lee M C, Gutierrez J, Gerando M, Molmenti E, Fung J J. 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;  5 421-428
• 9 Yellon D M, Baxter G F. Sodium hydrogen exchange in myocardial reperfusion injury.  Lancet. 2000;  356 522-523
• 10 Kaczmarek I, Groetzner J, Mueller M, Landwehr P, Uberfuhr P, Nollert G, Meiser B, Reichart B. Impact of donor sodium levels on outcome after heart transplantation.  J Heart Lung Transplant. 2005;  24 928-931
• 11 Chen J M, Sinha P, Rajasinghe H A, Surutwala S J, McCue J D, McCarty M J, Caliste X, Hauff H M, John M, Edwards N M. Do donor characteristics really matter? Short- and long-term impact of donor characteristics on recipient survival, 1995 - 1999.  J Heart Lung Transplant. 2002;  21 608-610
• 12 Harada K, Franklin A, Johnson R G, Grossman W, Morgan J P. Acidemia and hypernatremia enhance postischemic recovery of excitation-contraction coupling.  Circ Res. 1994;  74 1197-1209
• 13 Imahashi K, Kusuoka H, Hashimoto K, Yoshioka J, Yamaguchi H, Nishimura T. Intracellular sodium accumulation during ischemia as the substrate for reperfusion injury.  Circ Res. 1999;  84 1401-1406
• 14 Iwai T, Tanonaka K, Inoue R, Kasahara S, Motegi K, Nagaya S, Takeo S. Sodium accumulation during ischemia induces mitochondrial damage in perfused rat hearts.  Cardiovasc Res. 2002;  55 141-149
• 15 Kuznetsov A V, Brandacher G, Steurer W, Margreiter R, Gnaiger E. Estimation of mitochondrial damage in heart preservation.  Transplant Proc. 1999;  31 992
• 16 Jassem W, Fuggle S V, Rela M, Koo D D, Heaton N D. The role of mitochondria in ischemia/reperfusion injury.  Transplant. 2002;  73 493-499
• 17 White M, Wiechmann R J, Roden R L. et al . Cardiac beta-adrenergic neuroeffector systems in acute myocardial dysfunction related to brain injury. Evidence for catecholamine-mediated myocardial damage.  Circul. 1995;  92 2183-2189
• 18 Salim A, Vassiliu P, Velmahos G C. et al . The role of thyroid hormone administration in potential organ donors.  Arch Surg. 2001;  136 1377-1380
• 19 Szabo G, Buhmann V, Bahrle S, Vahl C F, Hagl S. Brain death impairs coronary endothelial function.  Transplant. 2002;  73 1846-1848
• 20 Hoefer D, Smits J MA, de Vries E, Antretter H, Laufer G. Elevated donor sodium levels are a risk factor for increased 1-year mortality after heart transplantation.  J Heart Lung Transplant. 2005;  25 (Suppl 1) S70