Preoperative characteristics of donors
There were 26 patients with hyponatremia, 104 patients with normonatremia and 90 patients with hypernatremia in donors, respectively. The BUN (P < 0.01) and Cr (P < 0.01) were significantly different in three groups, the BUN was 9.23 ± 0.65 mmoI/L and Cr was 129.57 ± 9.99 µmol/L in hypernatremia group, which were higher than those in the other groups. Age, gender, BMI, cause of death, ALT, AST, ALB, PT, INR, TBIL, and DBIL in the donor groups were not significantly different (Table 1).
Table 1: Perioperative characteristics of donors, categorized by donors’ serum sodium.
|
<135mmol/L(n=26)
|
135-145mmol/L(n=104)
|
>145mmol/L(n=90)
|
P value
|
Age (yr)
|
43.38 (2.54)
|
45.63 (1.08)
|
42.53 (1.40)
|
0.20
|
Gender (male/female)
|
23/3 (0.88/0.12)
|
90/14(0.87/0.13)
|
70/20(0.78/0.22)
|
0.20
|
BMI
|
26.12 (0.88)
|
26.38 (0.43)
|
25.24 (0.38)
|
0.15
|
Cause of death
|
|
|
|
0.75
|
Trauma
|
10 (0.38)
|
51(0.49)
|
42(0.47)
|
—
|
Cerebrovascular diseases
|
10(0.38)
|
37(0.36)
|
36(0.40)
|
—
|
Others
|
6 (0.24)
|
16(0.15)
|
12(0.13)
|
—
|
Sodium
|
130.71 (0.74)
|
140.19 (0.29)
|
157.01 (1.11)
|
<0.01
|
ALT
|
32.59 (5.10)
|
54.47 (9.21)
|
61.48 (8.57)
|
0.29
|
AST
|
46.71 (6.46)
|
56.80 (5.17)
|
86.97 (15.72)
|
0.07
|
ALB
|
38.75 (2.04)
|
35.91 (0.77)
|
35.01 (0.83)
|
0.12
|
PT
|
13.22 (0.66)
|
14.56 (0.85)
|
14.49 (0.75)
|
0.72
|
INR
|
1.18 (0.04)
|
1.18 (0.05)
|
1.18 (0.03)
|
1.00
|
TBIL
|
15.46 (2.15)
|
16.83 (1.45)
|
17.01 (1.28)
|
0.87
|
DBIL
|
6.46 (1.30)
|
8.30 (1.15)
|
8.76 (1.09)
|
0.64
|
BUN
|
6.89 (0.74)
|
6.37 (0.30)
|
9.23 (0.65)
|
<0.01
|
Cr
|
76.02 (13.24)
|
84.08 (7.90)
|
129.57 (9.99)
|
<0.01
|
Abbreviations: ALB, albumin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BUN, blood urea nitrogen; CIT, cold ischemia time; Cr, creatinine; DBIL, direct bilirubin; INR, international normalized ratio; PT, prothrombin time; TBIL, total bilirubin; WIT, warm ischemia time.
Preoperative characteristics of recipients
There were 176 recipients with normonatremia, 55 with hyponatremia and 17 patients with hypernatremia, respectively. In hyponatremia group, preoperative TBIL was 238.94±28.13 μmol/L (P<0.01), DBIL was 158.23±20.34 μmol/L (P<0.01), BUN was 8.25±0.72 mmoI/L (P<0.01), and Cr was 84.04±5.17 μmoI/L (P<0.01), all of them were significantly higher than those in the hypernatremia and normonatremia groups. Hence, the MELD scores (P<0.01) and MELD-Na scores (P<0.01) were significantly higher in the hyponatremia group. There was no significant difference in terms of age, gender, BMI, disease, ALT, AST, ALB, PT, and INR in the recipients (Table 2). The overall 1-year survival rate of recipients was 87.9%, the 2-year and 3-year survival rates were 82.2% and 80.9%, respectively.
Table 2: Perioperative characteristics of recipients, categorized by recipients’ serum sodium.
|
<135mmol/L(n=55)
|
130-145mmol/L(n=176)
|
>145mmol/L(n=17)
|
P value
|
Age (yr)
|
49.96 (1.34)
|
47.48 (0.75)
|
50.59(2.86)
|
0.17
|
Gender (male/female)
|
50/5 (0.91/0.09)
|
150/26 (0.85/0.15)
|
13/4 (0.76/0.24)
|
0.30
|
BMI
|
23.67 (0.53)
|
24.62 (0.22)
|
24.07(0.65)
|
0.14
|
Diseases
|
|
|
|
0.42
|
HCC
|
15 (0.27)
|
54 (0.31)
|
5 (0.29)
|
—
|
Cirrhosis
|
34 (0.62)
|
85 (0.48)
|
8 (0.47)
|
—
|
Liver failure
|
5 (0.09)
|
30 (0.17)
|
4 (0.24)
|
—
|
Others
|
1 (0.02)
|
7 (0.04)
|
0 (0)
|
—
|
Child-Pugh
|
10.45 (0.28)
|
9.19 (0.16)
|
9.47(0.59)
|
0.13
|
MELD
|
22.33 (1.21)
|
16.47 (0.63)
|
18.06(2.07)
|
<0.01
|
MELD-Na
|
26.56 (1.08)
|
16.58 (0.62)
|
18.06(2.07)
|
<0.01
|
Sodium
|
129.65 (0.75)
|
140.36 (0.21)
|
146.82(0.27)
|
<0.01
|
ALT
|
73.53 (18.98)
|
92.23 (13.71)
|
90.29(43.98)
|
0.77
|
AST
|
121.33 (18.98)
|
105.01 (18.64)
|
108.18 (70.36)
|
0.90
|
ALB
|
34.92 (1.83)
|
35.61 (0.52)
|
35.96(1.61)
|
0.86
|
PT
|
19.23 (0.95)
|
18.36 (0.74)
|
21.78 (2.83)
|
0.34
|
INR
|
2.29 (0.41)
|
1.74 (0.07)
|
1.97(0.24)
|
0.09
|
TBIL
|
238.94 (28.13)
|
120.79 (12.51)
|
107.96 (33.98)
|
<0.01
|
DBIL
|
158.23 (20.34)
|
81.98 (9.45)
|
67.5(21.36)
|
<0.01
|
BUN
|
8.25 (0.72)
|
5.65 (0.28)
|
6.55(1.07)
|
<0.01
|
Cr
|
84.04 (5.17)
|
68.49 (1.93)
|
64.04(6.19)
|
<0.01
|
Blood loss (ml)
|
1220.09 (226.04)
|
944.03 (65.18)
|
1011.76 (191.86)
|
0.26
|
Transfusion volume
|
|
|
|
|
RBC (U)
|
5.31 (0.80)
|
2.20 (0.22)
|
2.24 (0.72)
|
<0.01
|
FFP (ml)
|
1090.00 (124.91)
|
874.72 (51.47)
|
844.12 (142.06)
|
0.15
|
Abbreviations: ALB, albumin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BUN, blood urea nitrogen; Cr, creatinine; DBIL, direct bilirubin; FFP, fresh frozen plasma; HCC, hepatocellular carcinoma; INR, international normalized ratio; MELD, model for end-stage liver disease score; PT, prothrombin time; RBC, red blood cell; TBIL, total bilirubin.
Effects of donors’ serum sodium on prognosis
There was no significant difference in CIT, WIT and intraoperative blood loss, intraoperative transfusion and urine volume, postoperative hospital stays, or postoperative hepatic and renal function (Table S1). The survival rate within 3 years of the recipients classified according to donors’ serum sodium has not significantly different (P=0.37) (Fig. 1).
Effects of recipients’ serum sodium on prognosis
Intraoperative blood loss was 1220.09±226.04 ml in the hyponatremia group, which was higher than that in the other groups, but didn’t have significantly difference (P=0.26). Transfusion volume of RBC (P<0.01) was 5.31± 0.80 U in hyponatremia group, which was higher than the other groups. There was no significant difference in intraoperative urine volume, hospital stay, survival rate within postoperative 3 years (P=0.40) (Fig. 2), postoperative hepatic and renal function in the recipients classified by recipients’ preoperative serum sodium (Table S2).
Effects of delta serum sodium on prognosis
We divided the recipients into three groups according to delta serum sodium: 69 patients with delta sodium <0 mmol/l, 70 patients with delta sodium 0-10 mmol/l, and 81 patients with delta sodium >10 mmol/l. TBIL at 1 week postoperatively was significantly higher in the delta sodium <0 mmol/l group (81.67±10.54 μmol/L) than that in the other two groups (43.14±4.55 μmol/L, 63.40±7.49 μmol/L) (P<0.01). Similarly, DBIL at 1 week postoperatively was observably higher in the delta sodium <0 mmol/l group (60.71±7.61 μmol/L) than that in the other two groups (31.87±3.82 μmol/L, 49.35±6.22 μmol/L) (P<0.01). There was no difference in intraoperative urine volume, blood loss, postoperative renal function (Table 3), or survival rates within 3 years postoperatively among the three groups (P=0.58) (Fig. 3).
Two-group comparisons between the delta sodium groups showed that TBIL (P<0.01) and DBIL (P<0.01) at 1 week postoperatively were markedly different between the delta sodium <0 mmol/l group and the 0-10 mmol/L group, but the delta sodium >10 mmol/l group has no obvious different from the other groups (Table 4).
Table 3: Postoperative characteristics of recipients, categorized by delta serum sodium.
|
<0 mmol/L (n=69)
|
0-10 mmol/L (n=70)
|
>10 mmol/L (n=81)
|
P value
|
Blood loss (ml)
|
1041.30 (115.29)
|
878.33 (107.69)
|
1088.27 (154.04)
|
0.52
|
Transfusion volume
|
|
|
|
—
|
RBC (U)
|
2.52 (0.44)
|
2.84 (0.40)
|
3.41 (0.58)
|
0.42
|
FFP (ml)
|
875.36 (73.18)
|
931.16 (75.33)
|
844.44 (59.03)
|
0.72
|
Urine volume (ml)
|
1165.94 (74.55)
|
1263.91 (91.60)
|
1110.74 (62.39)
|
0.33
|
Hospital stays (d)
|
19.50 (7.25-33.25)
|
21.00 (15.00-28.25)
|
19.00 (15.00-29.00)
|
0.22
|
ALT by day 7
|
185.32 (38.67)
|
113.45 (22.19)
|
125.68 (19.30)
|
0.15
|
AST by day 7
|
252.00 (97.84)
|
75.96 (41.51)
|
76.88 (24.37)
|
0.07
|
TBIL by day 7
|
81.67 (10.54)
|
43.14 (4.55)
|
63.40 (7.49)
|
<0.01
|
DBIL by day 7
|
60.71 (7.61)
|
31.87 (3.82)
|
49.35 (6.22)
|
<0.01
|
BUN by day 7
|
10.86 (1.10)
|
11.33 (1.14)
|
12.10 (1.32)
|
0.77
|
Cr by day 7
|
84.57 (9.04)
|
78.55 (5.80)
|
96.68 (6.82)
|
0.72
|
ALT by month 1
|
31.64 (5.32)
|
29.09 (4.15)
|
31.43 (5.12)
|
0.92
|
AST by month 1
|
36.80 (7.68)
|
29.02 (2.80)
|
33.19 (4.30)
|
0.60
|
TBIL by month 1
|
28.53 (4.90)
|
20.65 (3.44)
|
27.12 (5.94)
|
0.51
|
DBIL by month 1
|
20.79 (4.11)
|
14.64 (3.03)
|
19.44 (4.65)
|
0.55
|
BUN by month 1
|
8.34 (1.10)
|
8.59 (1.61)
|
9.27 (1.59)
|
0.90
|
Cr by month 1
|
87.21 (7.45)
|
78.11 (5.26)
|
86.44 (9.75)
|
0.68
|
ALT by year 1
|
37.39 (7.21)
|
27.19 (3.90)
|
23.60 (2.87)
|
0.12
|
AST by year 1
|
37.41 (7.04)
|
34.04 (6.29)
|
24.13 (2.91)
|
0.19
|
TBIL by year 1
|
13.26 (2.13)
|
11.78 (0.97)
|
11.56 (0.98)
|
0.20
|
DBIL by year 1
|
7.62 (1.96)
|
5.30 (0.40)
|
5.70 (0.67)
|
0.13
|
BUN by year 1
|
6.20 (0.24)
|
9.05 (1.97)
|
8.68 (1.66)
|
0.35
|
Cr by year 1
|
83.56 (3.49)
|
89.22 (7.00)
|
77.65 (3.48)
|
0.22
|
ALT by year 3
|
19.83 (2.00)
|
20.64 (2.00)
|
22.23 (4.22)
|
0.84
|
AST by year 3
|
24.12 (2.31)
|
27.31 (3.43)
|
24.32 (3.22)
|
0.71
|
TBIL by year 3
|
16.41 (3.36)
|
26.73 (10.56)
|
17.48 (4.72)
|
0.50
|
DBIL by year 3
|
9.39 (2.51)
|
17.73 (8.64)
|
6.83 (1.31)
|
0.23
|
BUN by year 3
|
6.41 (0.28)
|
9.77 (2.65)
|
6.99 (0.43)
|
0.21
|
Cr by year 3
|
85.28 (3.82)
|
115.45 (19.10)
|
104.49 (15.34)
|
0.40
|
Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; Cr, creatinine; DBIL, direct bilirubin; FFP, fresh frozen plasma; RBC, red blood cell; TBIL, total bilirubin.
Table 4: Two groups comparison between delta sodium groups on postoperative TBIL and DBIL.
|
<0 VS 0-10 mmol/L
|
<0 VS >10mmol/L
|
0-10 VS >10mmol/L
|
TBIL by day 7
|
<0.01
|
0.41
|
0.07
|
DBIL by day 7
|
<0.01
|
0.58
|
0.05
|
Abbreviations: DBIL, direct bilirubin; TBIL, total bilirubin.