Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA.
Department of Medicine, Division of Gastroenterology, The Mount Sinai Hospital, New York, NY, USA.
Clin Transplant. 2021 May;35(5):e14276. doi: 10.1111/ctr.14276. Epub 2021 Mar 23.
Rapid changes in serum sodium (ΔSNa) peri-liver transplant (LT) predispose to post-LT neurological complications (NC). We aimed to assess whether implementation of a protocol directed at limiting peri-LT ΔSNa reduced post-LT NC. A retrospective single-center review of adult LT recipients from 1/2016 to 10/2017 was performed. Patients with hyponatremia (SNa < 135 mEq/L) within 7 days of LT were analyzed in two eras: pre-protocol (1/2016-9/2016) and post-protocol (10/2016-10/2017). The primary outcome was the development of NC within 1 month of LT. Perioperative ΔSNa (ΔSNaPost-LT) was assessed as a secondary outcome. Among 85 and 107 patients who underwent LT pre- and post-protocol, 39 (46%) and 42 (39%) were hyponatremic within 7 days of LT, respectively. Significantly fewer patients in the post-protocol era developed NC vs. pre-protocol (7.1% vs. 25.6%, p = .02). Additionally, fewer LT recipients in the post-protocol era developed ΔSNaPost-LT ≥ 10 mEq/L (9.5% vs. 30.7%, p = .02). Intraoperatively, more patients post-protocol received hypotonic saline (33.3% vs. 2.6%, p < .01). Multivariable logistic regression revealed that transplantation in the post-protocol era was associated with significantly reduced odds (odds ratio 0.11, 95% confidence interval 0.01-0.50) of developing NC. In conclusion, the implementation of a multidisciplinary protocol aimed at reducing ΔSNa peri-LT was independently associated with a reduction in post-LT NC.
肝移植（LT）前后血清钠（ΔSNa）的快速变化易导致 LT 后神经并发症（NC）。我们旨在评估实施旨在限制 LT 前后 ΔSNa 的方案是否可降低 LT 后的 NC。对 2016 年 1 月至 2017 年 10 月期间接受成人 LT 的患者进行了单中心回顾性研究。LT 后 7 天内出现低钠血症（SNa<135mEq/L）的患者分为两个时期进行分析：方案前（2016 年 1 月至 9 月）和方案后（2016 年 10 月至 2017 年 10 月）。主要结局是 LT 后 1 个月内发生 NC。作为次要结局评估 LT 后 ΔSNa（ΔSNaPost-LT）。在接受 LT 前和方案后的 85 例和 107 例患者中，分别有 39 例（46%）和 42 例（39%）在 LT 后 7 天内出现低钠血症。与方案前相比，方案后时期发生 NC 的患者明显较少（7.1% vs. 25.6%，p=0.02）。此外，方案后时期 LT 接受者中出现 ΔSNaPost-LT≥10mEq/L 的患者较少（9.5% vs. 30.7%，p=0.02）。术中，方案后时期更多患者接受低渗盐水（33.3% vs. 2.6%，p<0.01）。多变量逻辑回归显示，方案后时期的移植与 NC 发生的几率明显降低相关（比值比 0.11，95%置信区间 0.01-0.50）。总之，旨在降低 LT 前后 ΔSNa 的多学科方案的实施与 LT 后 NC 的降低独立相关。
