Prognostic factors influencing outcome in adult liver transplantation using hypernatremic organ donation after brain death |
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| Affiliation: | 1. Department of Gastroenterology, Qilu Hospital, School of Medicine, Shandong University, Jinan 250012, China;2. Department of Gastroenterology, Binzhou People''s Hospital, Binzhou 256610, China;1. Division of Hepatopancreatobiliary Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204, USA;2. Division of Transplant Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA;1. Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA;2. Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA;3. Starzl Unit of Abdominal Transplantation, Pôle de Chirurgie Expérimentale et Transplantation, Institute of Experimental and Clinical Research [IREC], Université catholique de Louvain, Brussels, Belgium;4. Department of General Surgery and Organ Transplantation, Sapienza University of Rome, Rome, Italy;1. HPB Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;2. Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;3. Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, UK |
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| Abstract: | BackgroundHypernatremic donors was regarded as the expanded criteria donors in liver transplantation. The study was to investigate the effects of donor hypernatremia on the outcomes of liver transplantation and identify the prognostic factors possibly contributing to the poor outcomes.MethodsDonor serum sodium levels before procurement were categorized as normal sodium (< 155 mmol/L), moderate high sodium (155–170 mmol/L), and severe high sodium (≥ 170 mmol/L). Furthermore, we subdivided the 142 hypernatremic donors (≥ 155 mmol/L) into two subgroups: subgroup A, the exposure time of liver grafts from hypernatremia to reperfusion was < 36 h; and subgroup B, the exposure time was ≥ 36 h. The outcomes included initial graft function, survival rates of grafts and recipients, graft loss and early events within the first year following liver transplantation.ResultsThere were no significant differences in the 1-year survival rates of grafts and recipients, 1-year graft loss rates and early events among the normal, moderate high and severe high sodium groups. However, the overall survival rates of grafts and recipients in subgroup A were significantly higher than those in subgroup B. Cox model showed that the exposure time (HR = 1.117; 95% CI: 1.053–1.186; P < 0.001), cold ischemia time (HR = 1.015; 95% CI: 1.006–1.024; P = 0.001) and MELD (HR = 1.061; 95% CI: 1.003–1.121; P = 0.037) were the important prognostic factors contributing to the poor outcomes of recipients with hypernatremic donors.ConclusionsThe level of donor sodium immediately before organ procurement does not have negative effects on the early outcomes following adult liver transplantation. For hypernatremia liver donors, minimization of the exposure time from hypernatremia to reperfusion is critical to prevent graft loss. |
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