Effect of hyponatraemia on outcomes following orthotopic liver transplantation

William A. Hackworth, Douglas M. Heuman, Arun J. Sanyal, Robert A. Fisher, Richard K. Sterling, Velimir A. Luketic, Mitchell L. Shiffman, Daniel Maluf, Adrian H. Cotterell, Marc P. Posner, Richard T. Stravitz

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Abstract

Background: Hyponatraemia increases risk of adverse outcomes following orthotopic liver transplantation (OLT), but it is unclear whether improvement of pretransplant hyponatraemia ameliorates post-transplant complications. Aims: To assess impact of pretransplant hyponatraemia onpost-transplant outcomes. Methods: We performed a retrospective analysis of 213 patients with cirrhosis who underwent liver transplantation. Patients with serum sodium ≤130 mEq/L immediately before transplantation ('hyponatraemia at OLT'; n = 34) were compared with those who had experienced hyponatraemia but subsequently improved to a serum sodium >130 mEq/L at transplantation ('resolved hyponatraemia'; n = 56) and to those without history of hyponatraemia before transplantation ('never hyponatraemic'; n = 123). Primary endpoint was survival at 180 days post-OLT. Secondary outcomes included time until discharge alive, complications during hospitalization, length of time ventilated and length of post-transplant intensive care unit stay. Results: There was no survival difference at 180 days post-OLT between groups. After transplantation, patients with either hyponatraemia at OLT or resolved hyponatraemia had longer time until discharge alive and had higher rates of delirium, acute renal failure, acute cellular rejection and infection than those who were never hyponatraemic. As compared with patients with hyponatraemia at OLT, those with resolved hyponatraemia were more likely to be discharged alive within 3 weeks, but other outcomes, including survival, did not differ significantly. Conclusions: We conclude that hyponatraemia at any time before liver transplantation is associated with adverse post-transplant outcome, even when hyponatraemia has resolved.

Original languageEnglish (US)
Pages (from-to)1071-1077
Number of pages7
JournalLiver International
Volume29
Issue number7
DOIs
StatePublished - Jul 20 2009

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Hyponatremia
Liver Transplantation
Transplantation
Transplants
Survival
Sodium
Delirium
Serum
Acute Kidney Injury
Intensive Care Units
Hospitalization
Fibrosis

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

Hackworth, W. A., Heuman, D. M., Sanyal, A. J., Fisher, R. A., Sterling, R. K., Luketic, V. A., ... Stravitz, R. T. (2009). Effect of hyponatraemia on outcomes following orthotopic liver transplantation. Liver International, 29(7), 1071-1077. https://doi.org/10.1111/j.1478-3231.2009.01982.x

Effect of hyponatraemia on outcomes following orthotopic liver transplantation. / Hackworth, William A.; Heuman, Douglas M.; Sanyal, Arun J.; Fisher, Robert A.; Sterling, Richard K.; Luketic, Velimir A.; Shiffman, Mitchell L.; Maluf, Daniel; Cotterell, Adrian H.; Posner, Marc P.; Stravitz, Richard T.

In: Liver International, Vol. 29, No. 7, 20.07.2009, p. 1071-1077.

Research output: Contribution to journalArticle

Hackworth, WA, Heuman, DM, Sanyal, AJ, Fisher, RA, Sterling, RK, Luketic, VA, Shiffman, ML, Maluf, D, Cotterell, AH, Posner, MP & Stravitz, RT 2009, 'Effect of hyponatraemia on outcomes following orthotopic liver transplantation', Liver International, vol. 29, no. 7, pp. 1071-1077. https://doi.org/10.1111/j.1478-3231.2009.01982.x
Hackworth WA, Heuman DM, Sanyal AJ, Fisher RA, Sterling RK, Luketic VA et al. Effect of hyponatraemia on outcomes following orthotopic liver transplantation. Liver International. 2009 Jul 20;29(7):1071-1077. https://doi.org/10.1111/j.1478-3231.2009.01982.x
Hackworth, William A. ; Heuman, Douglas M. ; Sanyal, Arun J. ; Fisher, Robert A. ; Sterling, Richard K. ; Luketic, Velimir A. ; Shiffman, Mitchell L. ; Maluf, Daniel ; Cotterell, Adrian H. ; Posner, Marc P. ; Stravitz, Richard T. / Effect of hyponatraemia on outcomes following orthotopic liver transplantation. In: Liver International. 2009 ; Vol. 29, No. 7. pp. 1071-1077.
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AU - Hackworth, William A.

AU - Heuman, Douglas M.

AU - Sanyal, Arun J.

AU - Fisher, Robert A.

AU - Sterling, Richard K.

AU - Luketic, Velimir A.

AU - Shiffman, Mitchell L.

AU - Maluf, Daniel

AU - Cotterell, Adrian H.

AU - Posner, Marc P.

AU - Stravitz, Richard T.

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N2 - Background: Hyponatraemia increases risk of adverse outcomes following orthotopic liver transplantation (OLT), but it is unclear whether improvement of pretransplant hyponatraemia ameliorates post-transplant complications. Aims: To assess impact of pretransplant hyponatraemia onpost-transplant outcomes. Methods: We performed a retrospective analysis of 213 patients with cirrhosis who underwent liver transplantation. Patients with serum sodium ≤130 mEq/L immediately before transplantation ('hyponatraemia at OLT'; n = 34) were compared with those who had experienced hyponatraemia but subsequently improved to a serum sodium >130 mEq/L at transplantation ('resolved hyponatraemia'; n = 56) and to those without history of hyponatraemia before transplantation ('never hyponatraemic'; n = 123). Primary endpoint was survival at 180 days post-OLT. Secondary outcomes included time until discharge alive, complications during hospitalization, length of time ventilated and length of post-transplant intensive care unit stay. Results: There was no survival difference at 180 days post-OLT between groups. After transplantation, patients with either hyponatraemia at OLT or resolved hyponatraemia had longer time until discharge alive and had higher rates of delirium, acute renal failure, acute cellular rejection and infection than those who were never hyponatraemic. As compared with patients with hyponatraemia at OLT, those with resolved hyponatraemia were more likely to be discharged alive within 3 weeks, but other outcomes, including survival, did not differ significantly. Conclusions: We conclude that hyponatraemia at any time before liver transplantation is associated with adverse post-transplant outcome, even when hyponatraemia has resolved.

AB - Background: Hyponatraemia increases risk of adverse outcomes following orthotopic liver transplantation (OLT), but it is unclear whether improvement of pretransplant hyponatraemia ameliorates post-transplant complications. Aims: To assess impact of pretransplant hyponatraemia onpost-transplant outcomes. Methods: We performed a retrospective analysis of 213 patients with cirrhosis who underwent liver transplantation. Patients with serum sodium ≤130 mEq/L immediately before transplantation ('hyponatraemia at OLT'; n = 34) were compared with those who had experienced hyponatraemia but subsequently improved to a serum sodium >130 mEq/L at transplantation ('resolved hyponatraemia'; n = 56) and to those without history of hyponatraemia before transplantation ('never hyponatraemic'; n = 123). Primary endpoint was survival at 180 days post-OLT. Secondary outcomes included time until discharge alive, complications during hospitalization, length of time ventilated and length of post-transplant intensive care unit stay. Results: There was no survival difference at 180 days post-OLT between groups. After transplantation, patients with either hyponatraemia at OLT or resolved hyponatraemia had longer time until discharge alive and had higher rates of delirium, acute renal failure, acute cellular rejection and infection than those who were never hyponatraemic. As compared with patients with hyponatraemia at OLT, those with resolved hyponatraemia were more likely to be discharged alive within 3 weeks, but other outcomes, including survival, did not differ significantly. Conclusions: We conclude that hyponatraemia at any time before liver transplantation is associated with adverse post-transplant outcome, even when hyponatraemia has resolved.

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