I. Clouse1, J. W. Clouse1, C. A. Kubal1, R. S. Mangus1 1Indiana University School Of Medicine,Surgery / Transplant,Indianapolis, IN, USA
Introduction:
Serum sodium level has recently been added to calculation of the model for end-stage liver disease (MELD) score because it is recognized as an important marker for disease severity in the cirrhotic patient. This study reviews all adult patients undergoing liver transplant at a single center over a 10-year time period to assess the impact of serum sodium levels on clinical outcomes.
Methods:
The records of all adult patients undergoing liver transplant at a single center from 2007 to 2018 were reviewed. Baseline and post-transplant serum sodium levels were recorded. Outcomes included length of stay and patient survival. Neurologic outcomes included any altered mental status, need for neurology consult and any required brain evaluation or imaging. Cox regression was used to assess 10-year patient survival.
Results:
There were 1,363 adult transplants reviewed during the study period. The median patient age was 57 years, with 67% being males and 89% being Caucasian. Etiologies of liver failure included hepatitis C (30%), fatty liver disease (21%), alcoholic liver disease (29%) and hepatocellular carcinoma (22%). The median MELD was 21, with median hospital stay of 10 days. There were 72% of patients with baseline serum sodium of 135mEq/L or higher, 20% were between 130 and 134mEq/L, and 8% (109 patients) with serum sodium less than 130mEq/L at transplant.
Patients older than 40 years of age were much more likely to present with hyponatremia (p=0.02), as well as those with alcoholic liver disease (p<0.01). Lower serum sodium levels were associated with higher MELD score. Patients with varying levels of hyponatremia did not differ in risk of perioperative death, 90-day death or in 1-year patient survival. They had similar hospital length of stay (12 versus 10 days, p=0.97). Hyponatremia was associated with 30-day post-transplant altered mental status (>25%, p=0.01) and with the request for neurology consultation (>20%, p<0.01). Brain studies in the first 30-day post-transplant were much more likely in hyponatremic patients (CT, p=0.07; MRI, p=0.05; and EEG, p<0.01). Cox regression 10-year patient survival demonstrates a decreasing survival from 75% down to 70% with increasing level of hyponatremia.
Conclusion:
These results provide a broader understanding of the impact of hyponatremia on post-liver transplant outcomes. There were 8% of patients going to the operating room with serum sodium level <130mEq/L. Though patient survival is similar, patients with hyponatremia are much more likely to require neurologic intervention and testing. At our center, efforts are made to maintain stable sodium levels during the transplant procedure, with slow increases in the days post-transplant up to the time of discharge.
