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Pretransplant severe hepatic encephalopathy, peritransplant sodium and post‐liver transplantation morbidity and mortality
Author(s) -
Brandman Danielle,
Biggins Scott W.,
Hameed Bilal,
Roberts John P.,
Terrault Norah A.
Publication year - 2012
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2011.02618.x
Subject(s) - medicine , liver transplantation , hepatic encephalopathy , gastroenterology , liver disease , hypernatremia , model for end stage liver disease , cohort , retrospective cohort study , encephalopathy , transplantation , sodium , cirrhosis , chemistry , organic chemistry
Background Hepatic encephalopathy ( HE ) does not enhance the prediction of model of end‐stage liver disease ( MELD ) wait‐list mortality, but its influence on post‐liver transplantation ( LT ) morbidity and mortality is largely unknown. Aims To examine the association between severe pre‐ LT HE and peri‐ LT serum sodium levels as well as post‐ LT length of stay ( LOS ) and survival. Methods A retrospective cohort of 393 adult patients undergoing first LT for end‐stage liver disease and followed for a median of 4 years post‐ LT was performed to evaluate the association between severe HE within the 30 days prior to LT and selected in‐hospital post‐ LT outcomes. Results Thirty‐nine (10%) of the cohort had severe HE pre‐ LT . Patients with severe HE more frequently had Na changes of ≥15 mmol/L in the peri‐ LT period ( P = 0.002). LOS was significantly longer for severe HE than non‐severe HE patients (16 vs. 8 days, P < 0.0001) and this association was independent of MELD , presence of hepatocellular carcinoma, pre‐ LT nadir serum sodium and pre‐ to post‐ LT change in serum sodium. The 1‐year mortality was 15% in the severe HE vs. 7% in the non‐severe HE groups ( HR = 2.19, P = 0.08), and this difference was attenuated by adjusting for pre‐ LT severe hypernatremia, but increased by adjusting for donor risk index. Conclusion Severe HE mainly affects LOS , and this association is independent of MELD . Whether the large changes in peri‐ LT serum Na, more frequently seen in the severe HE group, contribute to post‐ LT morbidity requires further study.