Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Clin Transplant. 2011 Jul-Aug;25(4):638-45. doi: 10.1111/j.1399-0012.2010.01350.x. Epub 2010 Nov 16.
The current policy for organ allocation in liver transplantation is to give priority to the sickest patients mostly using model for end-stage liver disease (MELD) score in ranking. However, other factors as serum sodium may be of value in predicting early mortality. In this single-center study, patients with cirrhosis over age 14 on the liver transplant wait-list from September 1998 to June 2007 were followed for six months from the time of listing to evaluate the value of hyponatremia on mortality. Of 612 listed patients, 51 were transplanted who were excluded from survival analysis and 55 died without transplantation within the first three months. The numbers of transplanted and dead patients during months 3-6 were 29 and 24, respectively. Both MELD score and serum sodium at the time of listing were independent predictors of early mortality. On bivariate analysis, serum sodium of <130 mEq/L beside MELD was a significant predictor of mortality within 90 and 180 d. Serum sodium level <135 mEq/L masked the difference in mortality between patients with refractory and non-refractory ascites. Serum sodium level of <130 mEq/L and an increased MELD score are significant predictors of early mortality in patients listed for liver transplantation.
目前，肝移植器官分配政策优先考虑最病重的患者，主要采用终末期肝病模型（MELD）评分进行排序。然而，血清钠等其他因素在预测早期死亡率方面可能具有价值。在这项单中心研究中，1998 年 9 月至 2007 年 6 月期间，在肝移植等待名单上年龄超过 14 岁的肝硬化患者，在列入名单后的六个月内进行随访，以评估低钠血症对死亡率的影响。在 612 名列入名单的患者中，有 51 名患者接受了移植，这些患者被排除在生存分析之外，有 55 名患者在头三个月内未接受移植而死亡。在第 3 至 6 个月期间，接受移植的患者和死亡的患者分别为 29 名和 24 名。在单变量分析中，列入名单时的 MELD 评分和血清钠均是早期死亡率的独立预测因素。在双变量分析中，除 MELD 外，血清钠<130 mEq/L 是 90 和 180 天内死亡的显著预测因素。血清钠水平<135 mEq/L 掩盖了难治性和非难治性腹水患者死亡率之间的差异。血清钠水平<130 mEq/L 和 MELD 评分升高是肝移植患者早期死亡率的显著预测因素。
