AI Article Synopsis
- Hyponatremia before liver transplant increases the risk of neurological complications post-transplant, but the impact of sodium changes around the time of surgery on these complications was unclear.
- A review of 1265 liver transplant patients showed that a larger change in sodium levels from before to after the transplant (delta sodium) is linked to a higher likelihood of experiencing CNS issues, with a 47% increase in risk for every 5 mmol/L rise in sodium.
- Maintaining stable serum sodium levels during the perioperative period is important to potentially reduce post-transplant neurological complications, especially for patients who start with hyponatremia.
Article Abstract
Background: Hyponatremia before liver transplant (LT) increases risk of post-LT neurological complications in patients with decompensated cirrhosis, but it is unknown to what extent change in sodium from pre- to post-LT influences risk of central nervous system (CNS) sequelae. We assessed the relationship between pre- to post-LT delta sodium and prevalence of CNS complications during LT hospitalization.
Methods: We performed retrospective single-center chart review of 1265 adults with cirrhosis who underwent LT (2011-2020). Delta sodium is defined as the difference between maximum sodium within 48 h post-LT and lowest sodium within 7 d pre-LT. Primary outcomes are post-LT CNS events during same hospitalization-encephalopathy, delirium, seizure, coma, osmotic demyelination syndrome, or other altered mental status, determined by International Classification of Diseases codes. Secondary outcome is length of hospital stay post-LT (LOS). Logistic regression modeled association between delta sodium and post-LT CNS outcomes; negative binomial regression modeled LOS.
Results: Median age was 59 y, 36% were female, and median Model for End-Stage Liver Disease score was 20. Median delta sodium was 8 mmol/L (interquartile range, 5-11). One hundred ninety-four (15%) experienced post-LT CNS complications. In multivariable analysis, controlling for confounders including pre-LT hyponatremia, every 5 mmol/L increase in delta sodium associated with 47% greater odds of CNS complication (95% confidence interval, 22%-77%). Delta sodium also associated with 7% increased LOS in adjusted regression (95% confidence interval, 3%-12%).
Conclusions: Adult LT recipients with higher perioperative delta sodium shifts displayed a higher risk of post-LT CNS complications, even after adjusting for pre-LT sodium. LT recipients, even those with pre-LT hyponatremia, may benefit from maintenance of stable serum sodium levels to minimize post-LT CNS complications.
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| http://dx.doi.org/10.1097/TP.0000000000004102 | DOI Listing |
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