LIVER-TRANSPLANTATION IN HYPONATREMIC PATIENTS WITH EMPHASIS ON CENTRAL PONTINE MYELINOLYSIS

Patients awaiting liver transplantation may suffer from severe hyponat remia. It has been suggested that hyponatremia or its treatment might be associated with central pontine myelinolysis (CPM), a serious compl ication that can be seen after orthotopic liver transplantation (OLT). We undertook this study to assess the outcome of hyponatremic patient s after OLT and to evaluate the risk factors in the development of CPM . A total of 379 adult OLT performed in 347 patients between March 199 3 and December 1995 was studied using a prospectively-collected data b ase and retrospective chart review. The following risk factors for the development of CPM were analyzed: primary liver disease, nutritional status, alcoholism, diuretic use, hepatic encephalopathy, United Netwo rk for Organ Sharing (UNOS) status, preoperative serum sodium, magnesi um and cholesterol levels, increase in serum sodium concentration duri ng surgery, and immunosuppressive treatment. Overall 12 patients (3.5% ) underwent OLT in a hyponatremic state (serum sodium less than or equ al to 127 meq/L). At a median follow-up of 14 months, 8 patients were alive without any neurological sequel. Six of the 12 patients develope d neurological complications in the early postoperative period includi ng CPM in 3, confusion in 2, and seizure in 1. The 3 patients who deve loped CPM expired within 3 months of OLT. The changes in serum sodium concentration during OLT in patients with and without CPM were 20.7 +/ - 8.1 and 7.0 +/- 5.1 meq/L, respectively (p = 0.005). No other risk f actor could be identified in the development of CPM. It is concluded t hat prognosis of hyponatremic patients after OLT is poor if they devel op CPM. Slow correction of hyponatremia perioperatively may be critica l in preventing this devastating complication.