Gastroenterology

Gastroenterology

Volume 130, Issue 4, April 2006, Pages 1135-1143
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Hyponatremia Impairs Early Posttransplantation Outcome in Patients With Cirrhosis Undergoing Liver Transplantation

https://doi.org/10.1053/j.gastro.2006.02.017Get rights and content

Background & Aims: Hyponatremia is associated with reduced survival in patients with cirrhosis awaiting liver transplantation. However, it is not known whether hyponatremia also represents a risk factor of poor outcome after transplantation. We aimed to assess the effects of hyponatremia at the time of transplantation on posttransplantation outcome in patients with cirrhosis. Methods: Two-hundred forty-one consecutive patients with cirrhosis submitted to liver transplantation during a 4-year period (January 2000–December 2003) were included in the study. The main end point was survival at 3 months after transplantation. Secondary end points were complications within the first month after transplantation. Results: Patients with hyponatremia (serum sodium lower than 130 mEq/L) had a greater incidence of neurologic disorders, renal failure, and infectious complications than patients without hyponatremia (odds ratio; 4.6, 3.4 and 2.7, respectively) within the first month after transplantation. By contrast, hyponatremia was not associated with an increased incidence of severe intra-abdominal bleeding, acute rejection, or vascular and biliary complications. Hyponatremia was an independent predictive factor of early posttransplantation survival. Three-month survival of patients with hyponatremia was 84% compared with 95% of patients without hyponatremia (P < .05). Survival was similar after 3 months. Conclusions: In patients with cirrhosis, the presence of hyponatremia is associated with a high rate of neurologic disorders, infectious complications, and renal failure during the first month after transplantation and reduced 3-month survival. In cirrhosis, hyponatremia should be considered not only a risk factor of death before transplantation but also a risk factor of impaired early posttransplantation outcome.

Section snippets

Study Population

The current investigation is a single-center retrospective cohort study of 241 consecutive adult patients with cirrhosis submitted to liver transplantation at the Hospital Clínic of Barcelona during a 4-year period (January 2000–December 2003). Seventy other patients undergoing transplantation also at our center during this period of time were excluded from the study because of retransplantation (n = 24), liver diseases other than cirrhosis (acute liver failure [n = 19], familial amyloidotic

Characteristics of the Patients

The study population includes 241 consecutive adult patients with cirrhosis undergoing liver transplantation during a 4-year period, from January 2000 to December 2003. Two hundred six out of the 241 patients included in the study (85%) received a liver from a cadaveric donor, whereas the remaining 35 patients (15%) received a graft from a living donor. Demographic, clinical, and biochemical data of patients included in the study at time of transplantation are shown in Table 1.

Prevalence of Hyponatremia at Transplantation

Nineteen of the

Discussion

The main finding of the current study is that pretransplantation hyponatremia was associated with an impaired short-term posttransplantation outcome in a series of 241 consecutive patients with cirrhosis undergoing transplantation in a single institution over a 4-year period. Patients with hyponatremia at time of transplantation had a greater risk of major posttransplantation complications within the first month after transplantation, including neurologic disorders, renal failure, and

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    Supported by grants from the Fondo de Investigación Sanitaria (FIS 05/0246), Ministerio de Educación y Ciencia (SAF 2005-01917), and Instituto de Salud Carlos III (CO3/2 and CO3/3) and a research grant from Fundación Carolina (to M-C.L).

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