Background: Donor hypernatremia remains a concern for some transplant centers when appraising the viability of a potential liver graft. This study examines the practice of routinely utilizing donor liver grafts from deceased donors with severe hypernatremia in the pediatric population.
Methods: This is a single-center retrospective review of 154 pediatric liver transplants from 2001-2022. Donor hypernatremia is grouped based on both peak and terminal sodium levels obtained from organ procurement records (normal, <150 mEq/L; moderate, 150-159 mEq/L; severe, ≥160 mEq/L). Outcomes include post-transplant peak alanine aminotransferase and total bilirubin levels, recipient length of hospital stay, early allograft dysfunction, and graft and patient survival at 7 days, 30 days, and 1-year post-transplant.
Results: There were 154 pediatric liver transplants performed during the study period. Of those, 32 donors (21%) were normonatremic, 49 (32%) moderately hypernatremic, and 73 (47%) severely hypernatremic based on peak serum sodium. Just prior to procurement, 96 donors (62%) were normonatremic, 32 (21%) moderately hypernatremic, and 26 (17%) severely hypernatremic. There was a trend towards more early allograft dysfunction with donor hypernatremia (p=0.10). Graphs and scatterplots of post-transplant transaminase levels fail to show a positive association with donor hypernatremia. While graft and patient survival at 7-days and 30-days did not show a statistically significant difference, 1-year patient survival and Kaplan-Meier estimation showed a trend toward lower patient survival with severely hypernatremic donors (p = 0.06). An increased incidence of early allograft dysfunction in recipients from severely hypernatremic donors was also noted (p = 0.10). Kaplan-Meier estimation of 1-year graft survival stratified by terminal serum sodium showed no difference (p = 0.50).
Conclusions: Pediatric liver transplant recipients have similar post-transplant clinical outcomes in the setting of normal or moderately elevated donor serum sodium. There is evidence to suggest that severe elevations in donor serum sodium (≥160 mEq/L) may impact early graft function and recipient survival. Most donors procured by our local organ procurement organization are actively managed to decrease serum sodium prior to procurement with good outcomes.