Severe hypernatremia in deceased liver donors does not impact early transplant outcome

There may be an increased risk of primary nonfunction in livers procured from donors with hypernatremia. The purported mechanism for this effect is undefined. This study analyzes early graft function for donor livers procured from patients with severe hypernatremia.

The organ procurement records for 1013 consecutive deceased liver donors between 2001 and 2008 were reviewed. Both peak and terminal serum sodium levels were categorized as (1) severe for a level 170 mEq/L or higher, (2) moderate for 160 to 169 mEq/L, and (3) normal for less than 160 mEq/L. Outcomes included 30-day posttransplant alanine aminotransferase and total bilirubin, primary nonfunction, and 30-day and 1-year graft survival.

Within the severe hypernatremia group, there were 142 (peak) and 50 (terminal) donors, whereas the moderate group had 233 (peak) and 162 (terminal) donors. The study groups did not differ in recipient age, model for end-stage liver disease score, steatosis, and ischemia times for the peak or terminal serum sodium groups. The differing levels of hypernatremia severity did not differ importantly, for peak or terminal serum sodium, in posttransplant alanine aminotransferase or total bilirubin, or the risk of intraoperative death and primary nonfunction. Thirty-day and 1-year graft survival did not demonstrate a negative impact from donor hypernatremia.

Posttransplant measures of early liver function and risk of failure, up to 1-year posttransplant, did not differ significantly based on peak or terminal donor serum sodium levels. These results suggest that donor serum sodium level likely has little clinical impact on posttransplant liver function.