The impact of recipient hypernatremia on pediatric liver transplantation outcomes

In pediatric liver transplants, dysnatremias have been found to have an impact on pretransplant and posttransplant outcomes. However, much of the current literature has focused on waitlist survival, secondary organ damage, and dysnatremia in donors rather than in recipients. To understand the effect of recipient immediate pretransplant hypernatremia on posttransplant mortality, we conducted a multivariable retrospective review analyzing data from 8011 pediatric patients undergoing liver transplantation provided by the United Network for Organ Sharing (UNOS). Multivariable analysis of hypernatremia showed an increased risk of mortality (OR: 2.49, 95% CI: 1.75, 3.54 for a serum sodium between 150 and 155 mEq/L), while hyponatremia did not show a significant increase in relative risk for mortality (HR: 1.11, 95% CI: 0.75, 1.63 for a serum sodium between 125 and 130 mEq/L). Kaplan-Meier curves stratified by sodium level showed statistically significant differences in outcomes with progressively increasing mortality associated with increasing serum sodium levels. In particular, there is a statistically significant increase in 90-day mortality with serum sodium levels above 150 mEq/L. Hyponatremia had a moderate impact on mortality but was not statistically significant. Our analysis of immediate pretransplantation resolution of hypernatremia also showed improved survival outcomes with a decreased mortality compared to transplant patients with unresolved hypernatremia. In conclusion, immediate pretransplant recipient hypernatremia has a substantial impact on pediatric post-liver transplantation survival. Corrected hypernatremia resulted in decreased mortality compared to uncorrected hypernatremia. Recipient hypernatremia is an important indicator of disease processes and a predictor of poor posttransplantation mortality outcomes.