Survival, MELD-Sodium and Serum Sodium Post-Liver Transplantation

Abstract

Introduction: Brazil is the largest public transplant system in the world. Recently, the MELD-Sodium score was incorporated in Brazil as a model to predict severity of liver disease. In international studies, it was observed that below normal serum sodium values are associated to graft loss. However, its relationship with prognostic factors in postoperative survival is still uncertain. Purposes: To contribute to implement screening prognostic factor strategies in post-liver transplantation. Methods: Retrospective longitudinal study including patients who underwent liver transplantation between the dates 01/01/2016 and 12/31/17, and who had one-year medical follow-up after the date of the transplant. Results: Final sample of 148 patients, from whom n = 105 were male with mean age of 52 years +111.7 and n=139, and declared themselves as white. N=50 individuals were bearer of alcoholic cirrhosis, and n=32 viral hepatitis. The time on the waiting list for liver transplant was 68 days+1113. The average MELD score was 20.7 +1 5.56, while MELD-Na was 13.8+15.31. MELD-Na values <15 (n=105), MELD-Na > 15 (n = 43) were found. The overall 6-month survival rate was 68.9% in 61.4% at 12 months and 56.7% at 24 months. Preoperative hyponatremia (< 135 mEq / L) present in 33 patients, in which n=14 died within six post-transplant months, n=4 in 12 months, and n=1 in 24 months. The analysis between hyponatremia and death obtained p<0,05. MELD-Na >15 (n = 43), from which n=17 died within six post-transplant months, n=3 in 12 months and n=1 in 24 months. Upon assessing the MELD score, values>20 (n=89) were significant predictors of death (p<0.05), adjusting it for the MELD-Na score, values>15 (n=43) were significant predictors of death (p<0.05). Conclusion: The monitoring of preoperative hyponatremia and the use of MELD-Na to define priority as to procedure on the waiting list should be strongly encouraged as a way to reduce post-liver transplant mortality rate.