Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: Effect of correction of donor hypernatremia

Abstract

Donor hypernatremia was reported to cause postoperative graft dysfunction in human orthotopic liver transplantation (OLT). However, the effects of the correction of donor hypernatremia before organ procurement have not been confirmed. The aim of this study is to determine whether donor hypernatremia is associated with early graft dysfunction after OLT and to determine the effect of the correction of donor hypernatremia. One hundred eighty-one consecutive OLTs performed between May 1997 and July 1998 were entered onto this study. The cases were divided into three groups according to the donor serum sodium concentration: group A, serum sodium of 155 mEq/L or less before organ procurement (n ‫؍‬ 118); group B, peak sodium greater than 155 mEq/L and final sodium 155 mEq/L or less (n ‫؍‬ 36); and group C, final sodium greater than 155 mEq/L (n ‫؍‬ 27). Graft survival within 90 days after OLT and early postoperative graft function were analyzed. There were no significant differences in donor and recipient variables among the three groups. The frequencies of graft loss were 15 of 118 grafts (12.7%) in group A, 4 of 36 grafts (11.1%) in group B, and 9 of 27 grafts (33.3%; P F .05 v groups A and B) in group C. The liver enzyme values in groups B and C were significantly greater than those in group A postoperatively. The prothrombin times of group C were significantly longer than those of group A for the first 4 postoperative days. Recipients of hepatic allografts from donors with uncorrected hypernatremia had a significantly greater incidence of graft loss compared with recipients of hepatic allografts from normonatremic donors. However, the differences in graft survival were abrogated by the correction of donor hypernatremia before procurement. Copyright 1999 by the American Association for the Study of Liver DiseasesS everal retrospective analyses of donor and recipient variables have attempted to identify risk factors predictive of both patient and graft survival after orthotopic liver transplantation (OLT). To date, the following donor-associated risk factors have been shown to adversely affect patient or graft survival: donor age, 1,2 sex, 3,4 liver function test results, 5 cytotoxic cross-match, 6 length of intensive care unit (ICU) stay, 1 use of vasopressors, 7 and preservation time. 2,8,9 Previously, all these risk factors were considered static and not subject to manipulation by the procurement team, primarily because of time constraints. However, recent legislation requiring earlier notification of potential organ donors and earlier turnaround time for serum chemistries have provided additional time to manage brain-dead donors before organ procurement and correct such abnormalities as hypernatremia that may adversely impact on both graft and recipient survival.Uncorrected hypernatremia in organ donors has been associated with poor graft or patient survival in at least four studies. 7,9-11 These retrospective analyses suggested donor hypernatremia resulted in a greater incidence of early postoperative graft dys...

Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function

“…In fact, allograft function from donors whose serum sodium was corrected to levels below 155 mEq/mL was comparable to those organs taken from normonatremic donors. 1 On the other hand, in the study by Londono et al, 5 the authors showed that recipient hyponatremia (serum sodium Ͻ 130 mEq/mL) reduced 3-month survival following OLT. From these observations, one can infer that both the donor sodium level at the time of organ procurement and the recipient serum sodium level at the time of transplantation can significantly impact post-OLT outcomes.…”

O doador marginal: experiência de um centro de transplante de fígado

“…Idade do doador e hipernatremia está relacionada à alta mortalidade pós-operatória, mas novamente, os estudos publicados são conflitantes 23 . Não existe consenso sobre a idade do doador que comprometeria a função do enxerto.…”

Anesthetic considerations in organ procurement surgery: a narrative review

“…Donors with serum sodium levels [ 155 mEqÁL -1 showed a significantly increased rate of early graft loss, while those with corrected serum sodium levels did not show such an increased rate of early graft loss. 61 The hypernatremia in brain death should be considered a hypovolemic state. If serum sodium levels persist [ 155 mEqÁL -1 following adequate volume resuscitation, the authors suggest infusion of a hypotonic solution, such as 0.45% NaCl (77 mEqÁL -1 ), as a maintenance fluid.…”