T. J. Hathaway1, J. R. Schroering1, C. A. Kubal1, G. S. Rao2, J. P. Molleston2, R. S. Mangus1 1Indiana University School Of Medicine,Department Of Surgery, Transplant Division,Indianapolis, IN, USA 2Indiana University School Of Medicine,Department Of Pediatric Gastroenterology,Indianapolis, IN, USA
Introduction:
Donor hypernatremia remains a concern for many transplant centers when appraising the usability of a potential liver graft. This study examines the practice of routinely utilizing donor liver grafts from deceased donors with severe hypernatremia in the pediatric population at our center.
Methods:
This is a single-center retrospective review of all pediatric liver transplants over a 17-year period. Donors are grouped based on both the peak and terminal serum sodium levels (level of hypernatremia) obtained from organ procurement records (normal/mild, less than 160mEq/L; moderate, 160-169mEq/L; and severe, greater than or equal to 170 mEq/L). Outcomes measured in this study include post-transplant peak alanine aminotransferase (ALT) and total bilirubin levels, recipient length of hospital stay (LOS), patient death within 24 hours of transplant, and graft survival at 7 days, 30 days, and 1-year post-transplant.
Results:
There were 118 pediatric liver transplants performed during the study period. Regarding peak donor sodium levels, there were 20 donors (19%) that had severe hypernatremia (≥170 mEq/L), and 31 donors (29%) that had moderate hypernatremia (160-169 mEq/L). Regarding terminal donor sodium levels, only 4 donors (4%) remained severely hypernatremic, and 14 donors (13%) remained moderately hypernatremic, at the time of procurement. Of the entire cohort, 3 patients died within 24 hours of transplant. These three grafts had a peak sodium level that was severely hypernatremic, however each had been corrected to normal levels prior to organ procurement. Graft survival at 7 days, 30 days, and 1-year did not differ significantly among the groups for both peak and terminal measures.
Conclusion:
Pediatric liver transplant recipients receiving grafts from donors with both moderate and severe hypernatremia had similar post-transplant clinical outcomes compared to those grafts from donors with serum sodium less than 160mEq/L. This was true for both peak and terminal levels. Clearly, most donors are actively managed to decrease serum sodium levels as there were 49 donors with moderate to severe peak sodium levels, but only 18 with these high levels for terminal measures.
