The Effect Of Recipients' Preoperative Serum Sodium Concentration On Prognosis Of Liver Transplantation.

Obejectives:1.To analyze the relationship between preoperative hyponatremia and preoperative physical condition of liver transplantation recipients and it's effect on prognosis.2.To analyze the relationship between preoperative hypernatremia and preoperative physical condition of liver transplantation recipients and it's effect on prognosis.Methods:1.Retrospectively collected the clinical data of 281 recipients underwent liver transplantation in the First Affiliated Hospital of ZhengZhou University from January 2016 to September 2017.According to the preoperative serum sodium concentration,they were divided into hyponatremia group(<130mmol/L)18 patients,normonatremia group(130-145mmol/L)232 patients and hypernatremia group(>145mmol/L)31 patients.The spss21.0 statistical software was used to analyze the difference of preoperative MELD score,Child-pugh score,postoperative survival rate and the incidence of graft dysfunction among three groups.Multivariate comparisons of measurement data were performed using analysis of variance.Pairwise comparisons between groups were performed using the LSD-t test.Chi-square tests were used to compare the count data sets.2.Searched the keywords group on MEDLINE/PubMed,EMBASE,Web of Science,Cochrane Library,and other literature databases,collected all of published literature about the impact of recipients' preoperative hyponatremia on prognosis of liver transplantation.The preoperative MELD score,postoperative ICU stay,total postoperative hospital stay,postoperative 30-day,90-day and 1-year survival rates,the incidence of postoperative delirium,nervous system dysfunction,renal failure,infection and other kinds of complications were extracted from the included studies.The binary and continuous variables were compared using the odds ratio(OR),the weighted mean difference(WMD)or the mean difference(MD),respectively,and were represented by a 95% confidence interval.Results:1.The preoperative MELD score was 19.27±7.35,Child-pugh score was 10.39±2.28,serum creatinine concentration was 95.89±49.40?mol/L in hyponatremia group,the preoperative MELD score was 12.17±8.79(p=0.001),Child-pugh score 8.50±2.68(p=0.004)and serum creatinine was 66.07±24.1?mol/L(p<0.001)in normonatremia group,the difference between two groups were statistically significant.There were no significant difference in the length of postoperative ICU stay and postoperative hospital stay among the three groups,there were no significant difference in the postoperative 30-day and 90-day survival rates and the incidence of graft dysfunction.2.Thirteen articles were included contain 31,239 patients in total,including 4,486 hyponatraemia patients and 26,753 patients without hyponatremia.Preoperative hyponatremia patients had a higher preoperative MELD score compared with normonatremia patients(p<0.001),and longer postoperative hospital stay(p<0.001),postoperative one year survival rate was lower(p<0.001),the incidence of neurological complications(p<0.001),renal failure(P=0.004),postoperative infections(p<0.001)and other complications were higher in hyponatremia patients,the difference was statistically significant.However,postoperative ICU stay and postoperative 30-day and 90-day survival rates were not statistically different in patients with preoperative hyponatremia and normonatremia.Conclusions:1.Preoperative hyponatremia is an indicator of poorer preoperative physical condition in liver transplantation recipients,has no significant effect on survival rate and incidence of graft dysfunction in the early stage(<90 days),but adversely affect postoperative long-term survival rate and the incidence of complications.2.Preoperative hypernatremia doen't have relationship with preoperative physical condition in liver transplantation recipients,has no significant effect on early postoperative survival rate and incidence of graft dysfunction(<90 days).