Hyponatremia Is Associated With Increased Mortality in Children on the Waiting List for Liver Transplantation

Abstract

Background. Our aim was to determine whether hyponatremia is associated with waiting list or posttransplantation mortality in children having liver transplantation (LT). Methods. A retrospective analysis of the united network for organ sharing/organ procurement transplantation network database on pediatric LT performed between 1988 and 2016 was conducted. Hyponatremia was defined as a serum sodium of 130 mEq/L or below. Subjects were divided into 2 age groups: I (0–6 y old) and II (7–18 y old). Patient survival before and after LT, as well as graft survival, were compared in patients with and without hyponatremia. Multivariable Cox proportional hazards models were constructed for perioperative mortality. Results. Data from 6606 children were available for analysis of waiting list mortality, and 4478 for postoperative mortality. The prevalence of hyponatremia at the time of registration was 2.8% and 3.7% at the time of LT. Waiting list mortality in patients with hyponatremia was significantly higher in group I (P < 0.001) but not in group II (P = 0.09). In group I, the relative risk of mortality adjusted to pediatric end-stage liver disease score was significantly associated with hyponatremia (P < 0.001). A sodium level below 130 mEq/L (hazard ration [HR] = 1.7), younger age (group I) (HR = 2.01), and need for dialysis (HR = 2.3) were independent predictors for increased waiting list mortality. There was no difference in overall postoperative patient or graft survival related to hyponatremia. Conclusions. Hyponatremia is associated with increased waiting list mortality for pediatric LT candidates, particularly in younger children. Future studies examining incorporation of age-specific serum sodium levels into organ allocation policies in children seems warranted based on our findings.

Accumulation of Postoperative Unexpected Events Assessed by the Comprehensive Complication Index Are Prognostic Outcome Parameters After Kasai Procedure

“…Hyponatremia is a well-known sequelae of pediatric liver diseases, mainly associated with portal hypertension, systemic vasodilatation and hypovolemia. 29 Low sodium levels are considered a negative predictor for mortality in pediatric liver transplant candidates and more recently an association with poor outcome in biliary atresia children with cirrhosis has been reported. 29,30 All children with electrolyte substitution had already moderate to severe signs of liver cirrhosis in liver biopsies at KPE.…”

Accumulation of Postoperative Unexpected Events Assessed by the Comprehensive Complication Index® as Prognostic Outcome Parameters for Kasai Procedure

“…Though none of the Clavien–Dindo events (Grade I–IV) were significantly associated with a worse outcome at the one- and two-year follow-up, detailed analysis revealed a significant association of electrolyte substitutions (Grade I) for hyponatremia and early postoperative cholangitis (Grade II) with transplantation and death. Hyponatremia is a well-known sequela of pediatric liver diseases, mainly associated with portal hypertension, systemic vasodilatation, and hypovolemia [ 29 ]. Low sodium levels are considered a negative predictor for mortality in pediatric liver transplant candidates and, more recently, an association with poor outcome in biliary atresia children with cirrhosis has been reported [ 29 , 30 ].…”

“…Hyponatremia is a well-known sequela of pediatric liver diseases, mainly associated with portal hypertension, systemic vasodilatation, and hypovolemia [ 29 ]. Low sodium levels are considered a negative predictor for mortality in pediatric liver transplant candidates and, more recently, an association with poor outcome in biliary atresia children with cirrhosis has been reported [ 29 , 30 ]. All children with electrolyte substitutions already had moderate to severe signs of liver cirrhosis in liver biopsies at KPE.…”

Clinical Implications, Evaluation, and Management of Hyponatremia in Cirrhosis

“…European population based survey which included both in-patient and out-patients with cirrhosis J o u r n a l P r e -p r o o f showed that the prevalence of hyponatremia defined as ≤ 135 mmol/L and ≤ 130 mmol/L were 49.4% and 21.65 respectively (2).Severe hyponatremia (sNa<125 mmol/L) is seen in 6% while about 1.2% patients have sNa level of <120 mmol/L (2).Low sNa levels (<135 mmol/L) is associated with high prevalence of severe ascites often characterized by Refractory Ascites (RA), rapidly accumulating ascites and frequent requirement of Large Volume Paracentesis (LVP) in these patients while sNa level less than 130 mmol/L is associated with increased frequency of Hepatic Encephalopathy (HE), Spontaneous Bacterial Peritonitis (SBP) and Hepatorenal Syndrome (HRS) (2, 4). Finally, hyponatremia is the most common dyselectrolytemia in patients with advanced cirrhosis on liver transplantation (LT) waiting list and indicates a poor prognosis (5,6). Similarly, hyponatremia prior to LT, is associated with a stormy clinical course in the early post-transplant period (6,7).…”

“…Finally, hyponatremia is the most common dyselectrolytemia in patients with advanced cirrhosis on liver transplantation (LT) waiting list and indicates a poor prognosis (5,6). Similarly, hyponatremia prior to LT, is associated with a stormy clinical course in the early post-transplant period (6,7). Though a common entity in cirrhosis, management of hyponatremia is often challenging.…”