Extreme hyponatremia as a risk factor for early mortality after liver transplantation in the MELD-sodium era.
Extreme hyponatremia as a risk factor for early mortality after liver transplantation in the MELD-sodium era.
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DOI：
10.1111/tri.14123
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发表时间：
2021-12
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影响因子：
--
通讯作者：
Nagai S
中科院分区：
文献类型：
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作者：
Ivanics T;Leonard-Murali S;Mouzaihem H;Moonka D;Kitajima T;Yeddula S;Shamaa MT;Rizzari M;Collins K;Yoshida A;Abouljoud M;Nagai S
在实施基于MELD-Na的肝脏分配后，低钠血症对等待名单和移植后结局的影响仍不清楚。我们调查了低钠血症患者在实施基于MELD-Na的分配之前和之后的等待名单和肝移植（LT）后的结果。在OPTN/UNOS数据库中确定了2009年至2021年期间登记接受初次LT的成人患者。定义了两个时期：前MELD-Na和后MELD-Na。极端低钠血症定义为血清钠浓度≤ 120 mEq/l。采用Fine-Gray比例风险模型和混合效应考克斯比例风险模型比较了90天等待名单结果和LT后生存率。共有118487例患者符合条件（n = 64940：MELD-Na前; n = 53547：MELD-Na后）。在MELD-Na前时期，登记时的极端低钠血症与90天等待名单死亡风险增加（[ref：135 - 145] HR：3.80; 95% CI：2.97 - 4.87; P <0.001）和移植概率较高（HR：1.67; 95% CI：1.38 - 2.01; P <0.001）相关。在后MELD-Na时代，与血清钠水平正常（135 - 145）的患者相比，极端低钠血症患者的等待名单死亡率相对风险按比例降低（HR：2.27; 95% CI 1.60 - 3.23; P <0.001），移植概率按比例升高（HR：2.12; 95% CI 1.76 - 2.55; P <0.001）。与血清钠水平正常的患者相比，极端低钠血症与LT后90、180和365天生存率的风险较高相关。随着MELD-Na分配的引入，极低钠血症患者的等待名单结局有所改善，但他们的LT后短期生存率仍然较差。
The impact of hyponatremia on waitlist and post-transplant outcomes following the implementation of MELD-Na-based liver allocation remains unclear. We investigated waitlist and postliver transplant (LT) outcomes in patients with hyponatremia before and after implementing MELD-Na-based allocation. Adult patients registered for a primary LT between 2009 and 2021 were identified in the OPTN/UNOS database. Two eras were defined; pre-MELD-Na and post-MELD-Na. Extreme hyponatremia was defined as a serum sodium concentration ≤120 mEq/l. Ninety-day waitlist outcomes and post-LT survival were compared using Fine-Gray proportional hazard and mixed-effects Cox proportional hazard models. A total of 118 487 patients were eligible (n = 64 940: pre-MELD-Na; n = 53 547: post-MELD-Na). In the pre-MELD-Na era, extreme hyponatremia at listing was associated with an increased risk of 90-day waitlist mortality ([ref: 135–145] HR: 3.80; 95% CI: 2.97–4.87; P < 0.001) and higher transplant probability (HR: 1.67; 95% CI: 1.38–2.01; P < 0.001). In the post-MELD-Na era, patients with extreme hyponatremia had a proportionally lower relative risk of waitlist mortality (HR: 2.27; 95% CI 1.60–3.23; P < 0.001) and proportionally higher transplant probability (HR: 2.12; 95% CI 1.76–2.55; P < 0.001) as patients with normal serum sodium levels (135–145). Extreme hyponatremia was associated with a higher risk of 90, 180, and 365-day post-LT survival compared to patients with normal serum sodium levels. With the introduction of MELD-Na-based allocation, waitlist outcomes have improved in patients with extreme hyponatremia but they continue to have worse short-term post-LT survival.
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