2011 - ISBTS 2011 Symposium


Oral Communications 6: Surgical Aspects of ITX

8.150 - Extreme donor hypernatremia does not influence intestinal and multivisceral transplantation outcomes

Presenter: Jason, Hawksworth, Washington DC, United States
Authors: Jason Hawksworth1, Cal Matsumoto1, Raffaele Girlanda1, Juan Francisco Guerra1, Lee Cummings1, Stuart Kaufman1, Cheryl Little1, Eddie Island1, Jaqueline Laurin1, Rohit Satoskar1, Kirti Shetty1, Thomas Fishbein1


150
Extreme donor hypernatremia does not influence intestinal and multivisceral transplantation outcomes

Jason Hawksworth, Cal Matsumoto, Raffaele Girlanda, Juan Francisco Guerra, Lee Cummings, Stuart Kaufman, Cheryl Little, Eddie Island, Jaqueline Laurin, Rohit Satoskar, Kirti Shetty, Thomas Fishbein

Transplant Institute, Georgetown University Hospital, Washington, DC, United States

Extreme donor hypernatremia (peak sodium levels over 170 mEq/L) is classically thought to be donor risk factor for primary non function in liver transplantation. Recent evidence, however, has not supported the notion of hepatocyte injury in relation to donor hypernatremia. Little is known or understood regarding the effects of donor hypernatremia in intestinal transplantation (ITx).

Methods: We retrospectively evaluated the outcome of our ITx experience from donors with peak serum sodium (pNa) ≥170 mEq/L.

Results: 125 ITx were performed in 122 recipients from November 2003 to November 2010 with a median follow up of 36 months. Pediatric grafts included 18 small bowel (SB), 35 liver/intestine (L/I), and 10 multivisceral (MVTx). Adult grafts included 47 SB and 15 MVTx. 25/125 (20%) donors had a pNa of  ≥170 mEq/L (High pNa) with an average of 175.7 ± 5.4 mEq/L and 100 donors had a lower (Low pNa) with an average of 156.6 ± 8.9 mEq/L (p<0.001). Terminal donor sodium levels were also higher in the High pNa group compared to the Low pNa  group at 150.2 ± 10.9 mEq/L and 143.0 ± 10.3 mEq/L respectively (p=0.003). Donor and recipient characteristics including recipient age, donor age, number of pediatric patients, inclusion of liver allograft, and cold ischemia time (CIT) were not significantly different between the two groups. ITx outcomes including ventilator days, and postoperative TPN days, 1 year freedom from rejection (FFR), 1 year graft survival, and 3 year patient survival were not significantly different between the two groups.

Conclusions: Extreme donor hypernatremia does not appear to influence graft and patient outcomes and should not be used to exclude potential donors for intestinal and multivisceral transplantation.


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