Oehler Daniel, Immohr Moritz Benjamin, Böttger Charlotte, Bruno Raphael Romano, Sigetti Dennis, Haschemi Jafer, Aubin Hug, Horn Patrick, Tudorache Igor, Westenfeld Ralf, Akhyari Payam, Kelm Malte, Lichtenberg Artur, Boeken Udo
Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.
Cardiovascular Research Institute Düsseldorf, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany.
Clin Transplant. 2022 Dec;36(12):e14803. doi: 10.1111/ctr.14803. Epub 2022 Sep 20.
Donor hypernatremia has been associated with primary graft dysfunction in heart transplantation (HTx) and is correlated with impaired outcome following liver and renal transplantation. However, controversial data exist regarding the impact of sodium dysregulation on survival. This study aims to investigate the impact of donor sodium levels on early morbidity and short- and midterm survival following HTx.
Between September 2010 and June 2021, a total of n = 218 patients underwent HTx in our center. From those, 214 could be included retrospectively in our study. For each donor, sodium levels were collected and different cut-off levels from 145 to 159 mmol/L were investigated by Kaplan-Meier-analysis. Then, recipients were divided in three groups regarding donor sodium: Normonatremia (133-145 mmol/L, n = 73), mild hypernatremia (146-156 mmol/L, n = 105) and severe hypernatremia (>156 mmol/L, n = 35). Recipient and donor variables were reviewed and compared, including peri- and postoperative characteristics and recipient survival after up to 5 years after transplantation.
All patients were comparable regarding baseline characteristics and perioperative parameters. Regarding early mortality, 90-day survival was significantly reduced only in patients with severe donor hypernatremia in comparison to normonatremia (90% vs. 71%, p = .02), but not in mild hypernatremia (89%, p = .89). One-year survival was comparable in all groups (p > .28).
Severe donor hypernatremia was associated with reduced short-term survival, while the correlation weakens > 1 year after HTx. As our study is limited due to the nature of its retrospective, single-center approach, future prospective studies are needed to evaluate the importance of donor management with regard to hypernatremia.
供体高钠血症与心脏移植（HTx）中的原发性移植物功能障碍相关，并且与肝移植和肾移植后的不良预后相关。然而，关于钠代谢紊乱对生存率的影响，存在有争议的数据。本研究旨在调查供体钠水平对HTx后早期发病率以及短期和中期生存率的影响。
在2010年9月至2021年6月期间，共有n = 218例患者在我们中心接受了HTx。其中，214例可回顾性纳入我们的研究。对于每位供体，收集钠水平，并通过Kaplan-Meier分析研究145至159 mmol/L的不同临界值水平。然后，根据供体钠水平将受者分为三组：正常钠血症（133 - 145 mmol/L，n = 73）、轻度高钠血症（146 - 156 mmol/L，n = 105）和重度高钠血症（>156 mmol/L，n = 35）。回顾并比较受者和供体变量，包括围手术期和术后特征以及移植后长达5年的受者生存率。
所有患者在基线特征和围手术期参数方面具有可比性。关于早期死亡率，与正常钠血症相比，仅重度供体高钠血症患者的90天生存率显著降低（90%对71%，p = 0.02），而轻度高钠血症患者则未降低（89%，p = 0.89）。所有组的1年生存率相当（p > 0.28）。
重度供体高钠血症与短期生存率降低相关，而这种相关性在HTx后>1年时减弱。由于我们的研究因其回顾性、单中心方法的性质而受到限制，因此需要未来的前瞻性研究来评估供体高钠血症管理的重要性。
