Kaseje Neema, McLin Valerie, Toso Christian, Poncet Antoine, Wildhaber Barbara E
Divisions of Pediatric Surgery, University Hospitals Geneva, Geneva, Switzerland.
Division of Pediatrics, University Hospitals Geneva, Geneva, Switzerland.
Liver Transpl. 2015 Aug;21(8):1076-81. doi: 10.1002/lt.24145.
The demand for transplantable organs far outweighs the supply. Recently, efforts have been made to increase the donor pool by adopting extended criteria for livers, including those from hypernatremic donors. Currently, there is no clear evidence that the use of organs from hypernatremic donors has detrimental effects on pediatric liver transplantation (LT) recipients. Our aim was to use the Scientific Registry of Transplant Recipients database to evaluate the effects of donor hypernatremia on 30-day outcomes in pediatric LT recipients. We performed an analysis of 2325 children who underwent whole or partial LT between 2005 and 2010. First, we sought to determine a donor sodium threshold for increased mortality following pediatric LT. Second, we examined rates of mortality and graft failure at 30 days after LT in patients receiving grafts from hypernatremic donors compared to patients receiving grafts from normonatremic donors. Hypernatremia was defined as a donor sodium level of ≥160 µmol/L. The primary outcome measure was mortality at 30 days after transplant. The secondary outcome measure was graft failure at 30 days after transplant. There was no threshold sodium level for increased 30-day mortality following pediatric LT. Mean recipient ages/weights, Pediatric End-Stage Liver Disease/Model for End-Stage Liver Disease scores, and mean cold and warm ischemia times were similar between the 2 study groups. There were no significant differences in mortality rates (3.9% versus 4.5%; P = 0.87) and graft failure rates (2.2% versus 1.9%; P = 1.00) in patients receiving grafts from hypernatremic donors compared to patients receiving grafts from normonatremic donors at 30 days after LT. In conclusion, donor hypernatremia just before procurement does not appear to have negative effects on mortality and graft failure rates at 30 days following pediatric LT.
可移植器官的需求远远超过了供应。最近，人们通过采用更宽泛的肝脏捐赠标准（包括来自高钠血症捐赠者的肝脏）来努力增加捐赠者库。目前，尚无明确证据表明使用高钠血症捐赠者的器官会对小儿肝移植（LT）受者产生不利影响。我们的目的是利用移植受者科学注册数据库来评估捐赠者高钠血症对小儿LT受者30天结局的影响。我们对2005年至2010年间接受全肝或部分肝移植的2325名儿童进行了分析。首先，我们试图确定小儿LT后死亡率增加的捐赠者钠阈值。其次，我们比较了接受高钠血症捐赠者肝脏移植的患者与接受正常钠血症捐赠者肝脏移植的患者在LT后30天的死亡率和移植物失败率。高钠血症定义为捐赠者钠水平≥160µmol/L。主要结局指标是移植后30天的死亡率。次要结局指标是移植后30天的移植物失败。小儿LT后30天死亡率增加并无钠阈值。两个研究组之间的受者平均年龄/体重、小儿终末期肝病/终末期肝病模型评分以及平均冷缺血和热缺血时间相似。与接受正常钠血症捐赠者肝脏移植的患者相比，接受高钠血症捐赠者肝脏移植的患者在LT后30天的死亡率（3.9%对4.5%；P = 0.87）和移植物失败率（2.2%对1.9%；P = 1.00）无显著差异。总之，在获取肝脏前出现的捐赠者高钠血症似乎对小儿LT后30天的死亡率和移植物失败率没有负面影响。
