PRE-TRANSPLANT HYPONATREMIA COULD BE ASSOCIATED WITH A POOR PROGNOSIS AFTER LIVER TRANSPLANTATION

COMPLICATIONS - METABOLIC

I.F.S.F. Boin¹, C. Capel², E.C. Ataide¹, A.R. Cardoso¹, C.A. Caruy¹, R.S.B. Stucchi^1
1Unit Of Liver Transplantation, State University of Campinas, Campinas/BRAZIL, ²Surgery, Faculty of Medical Science, Campinas/BRAZIL

Body: Introduction: Predicting prognosis at the most accurate way in hepatic cirrhosis is essential to do a fairness allocation in liver transplantation waiting list and reduce mortality. Several researchers presently are comparing MELD to MELD Na with results pointing to the second parameter as a better instrument to evaluate the prognosis in liver cirrhosis.
Aim: To study the survival rate of the recipient liver transplantation in association with hyponatremia.
Method: This is an analytic and retrospective study. The characteristics from liver donor and recipient were: age (years). MELD UNOS score (total bilirubin. creatinine and IRN). MELD Na score (total bilirubin. creatinine. IRN. natremia). pre-transplant (p-t) BMI (body mass index). warm ischemia time (minutes). cold ischemia time (minutes). ICU time (days). hemocomponents use [cell saver (ml). FFP-frozen fresh plasma (ml). erythrocytes (ml)]. p-t glycemia (mg/dL). p-t serum sodium (mEq/L) and Child-Pugh classification. From February 99 to May all consecutive OLT (piggyback technique) were analyzed. split in two groups for comparison (A – [Na]> mEq/L and B – [Na]<mEq/L). survival (months). The Kaplan-Meier method was used to analyze survival rate and Cox regression test to identify predictive factors.
Results: There was statistical difference in the cumulative proportion surviving between the groups (P=.) by Cox-Mantel test. Cox regression test for survival time showed that patients with higher risk of death in recipients with low values of pre-transplant serum sodium (group B) were: Child-Pugh score with .% plus risk to death for each point. cold ischemia time with .% plus risk to death for each minute. glycemia with .9% plus risk to death for each mg. cell-saver with .66% plus risk to death for each ml. donor [Na] with .% plus risk to death for each mEq and donor age with .% plus risk to death for each year. Kolmogorov-Sminorv test showed that Hyponatremia group (B) had significant difference (black numbers)

	p-level	Mean A	Mean B	SD (A)	SD (B)	Valid N	Valid N
Survival time	p <.05	51.21	37.16	54.13	51.17	269	49
Age	p >.10	46.63	45.44	11.45	12.11	263	47
Child	p <.025	9.57	11.02	2.04	2.12	248	43
BMI	p <.05	26.15	24.40	4.54	4.24	261	46
Warm ischemia	p >.10	64.34	62.37	30.55	23.34	268	48
Cold ischemia	p <.05	687.58	630.30	186.72	190.95	269	49
ICU time	p >.10	11.04	19.70	15.28	44.73	223	41
MELD UNOS	p >.10	18.26	20.47	4.75	5.760	220	40
MELD_NA	p <.001	19.03	33.54	5.22	10.55	207	37
Glycemia	p <.025	103.78	116.23	43.73	42.26	266	47
Sodium	p <.001	136.64	126.57	3.70	4.87	269	49
Hemacea	p <.025	6.575	7.625	7.47	5.59	268	48

Conclusion: High Child-Pugh score values. cold ischemia time. glycose levels. use of cell-saver. serum sodium level of donor and donor age are variables that are found associated with the highest number of deaths and shorter survival.

Disclosure: All authors have declared no conflicts of interest.