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A protocol for the management of hyponatremia peri‐liver transplant reduces post‐transplant neurological complications

James F. Crismale,Tsipora M. Huisman,R. Deshpande,Cindy Law,G. Im,D. Bronster,S. DeMaria,S. Florman,T. Schiano

Published 2021 in Clinical Transplantation

ABSTRACT

Rapid changes in serum sodium (ΔSNa) peri‐liver transplant (LT) predispose to post‐LT neurological complications (NC). We aimed to assess whether implementation of a protocol directed at limiting peri‐LT ΔSNa reduced post‐LT NC. A retrospective single‐center review of adult LT recipients from 1/2016 to 10/2017 was performed. Patients with hyponatremia (SNa < 135 mEq/L) within 7 days of LT were analyzed in two eras: pre‐protocol (1/2016‐9/2016) and post‐protocol (10/2016‐10/2017). The primary outcome was the development of NC within 1 month of LT. Perioperative ΔSNa (ΔSNaPost‐LT) was assessed as a secondary outcome. Among 85 and 107 patients who underwent LT pre‐ and post‐protocol, 39 (46%) and 42 (39%) were hyponatremic within 7 days of LT, respectively. Significantly fewer patients in the post‐protocol era developed NC vs. pre‐protocol (7.1% vs. 25.6%, p = .02). Additionally, fewer LT recipients in the post‐protocol era developed ΔSNaPost‐LT ≥ 10 mEq/L (9.5% vs. 30.7%, p = .02). Intraoperatively, more patients post‐protocol received hypotonic saline (33.3% vs. 2.6%, p < .01). Multivariable logistic regression revealed that transplantation in the post‐protocol era was associated with significantly reduced odds (odds ratio 0.11, 95% confidence interval 0.01–0.50) of developing NC. In conclusion, the implementation of a multidisciplinary protocol aimed at reducing ΔSNa peri‐LT was independently associated with a reduction in post‐LT NC.

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