Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha 410011, China.
Center of Organ Transplantation, The Second Xiangya Hospital of Central South University, Changsha 410011, China.
Hepatobiliary Pancreat Dis Int. 2020 Aug;19(4):371-377. doi: 10.1016/j.hbpd.2020.06.003. Epub 2020 Jun 7.
Hypernatremic donors was regarded as the expanded criteria donors in liver transplantation. The study was to investigate the effects of donor hypernatremia on the outcomes of liver transplantation and identify the prognostic factors possibly contributing to the poor outcomes.
Donor serum sodium levels before procurement were categorized as normal sodium (< 155 mmol/L), moderate high sodium (155-170 mmol/L), and severe high sodium (≥ 170 mmol/L). Furthermore, we subdivided the 142 hypernatremic donors (≥ 155 mmol/L) into two subgroups: subgroup A, the exposure time of liver grafts from hypernatremia to reperfusion was < 36 h; and subgroup B, the exposure time was ≥ 36 h. The outcomes included initial graft function, survival rates of grafts and recipients, graft loss and early events within the first year following liver transplantation.
There were no significant differences in the 1-year survival rates of grafts and recipients, 1-year graft loss rates and early events among the normal, moderate high and severe high sodium groups. However, the overall survival rates of grafts and recipients in subgroup A were significantly higher than those in subgroup B. Cox model showed that the exposure time (HR = 1.117; 95% CI: 1.053-1.186; P < 0.001), cold ischemia time (HR = 1.015; 95% CI: 1.006-1.024; P = 0.001) and MELD (HR = 1.061; 95% CI: 1.003-1.121; P = 0.037) were the important prognostic factors contributing to the poor outcomes of recipients with hypernatremic donors.
The level of donor sodium immediately before organ procurement does not have negative effects on the early outcomes following adult liver transplantation. For hypernatremia liver donors, minimization of the exposure time from hypernatremia to reperfusion is critical to prevent graft loss.
高钠血症供体被视为肝移植的扩展标准供体。本研究旨在探讨供体高钠血症对肝移植结局的影响，并确定可能导致不良结局的预后因素。
将供体采集前的血清钠水平分为正常钠（<155mmol/L）、中高钠（155-170mmol/L）和高钠（≥170mmol/L）。此外，我们将 142 例高钠血症供体（≥155mmol/L）分为两个亚组：亚组 A，肝移植物从高钠血症到再灌注的暴露时间<36h；亚组 B，暴露时间≥36h。结果包括初始移植物功能、移植物和受者的存活率、移植物丢失和肝移植后 1 年内的早期事件。
正常、中高钠和高钠血症组供体和受者 1 年存活率、1 年移植物丢失率和早期事件发生率无显著差异。然而，亚组 A 的供体和受者总存活率明显高于亚组 B。Cox 模型显示，暴露时间（HR=1.117；95%CI：1.053-1.186；P<0.001）、冷缺血时间（HR=1.015；95%CI：1.006-1.024；P=0.001）和 MELD（HR=1.061；95%CI：1.003-1.121；P=0.037）是导致高钠血症供体受者不良结局的重要预后因素。
器官采集前供体钠水平对成人肝移植后早期结局无不良影响。对于高钠血症供体肝，最大限度地减少从高钠血症到再灌注的暴露时间对于防止移植物丢失至关重要。
