Risk factors for mortality on the liver waiting list of cirrhotic patients listed for liver transplantation

Abstract Background & Aims: Hyponatremia is an important predictor of early death among cirrhotic patients in the orthotopic liver transplantation (OLT) waiting list. Evidence exists that prioritizing OLT waiting list according to the MELD score combined with plasma sodium concentration might prevent pretransplantation death. However, the evolution of plasma sodium concentrations during the perioperative period of OLT is not well known. We aimed to describe the evolution of perioperative sodium concentration during OLT and its relation to perioperative neurohormonal responses.Methods: Twenty-seven consecutive cirrhotic patients who underwent OLT were prospectively included in the study over a period of 27 months. We studied the evolution of plasma sodium levels, the hemodynamics, the neurohormonal response and other biological markers during the perioperative period of OLT.Results: All patients with a hyponatremia before OLT were in the Child C group. None of the patients had acute or chronic renal impairment. Interestingly, in patients with hyponatremia, plasmatic sodium reached normal levels as soon as the injured livers were removed during surgery and the plasma sodium concentration remained within normal ranges 1 day, 7 days, as well as 6 months after surgery.Conclusions: Further investigation of rapid correction and stabilization of sodium levels after OLT, as observed in our study, would be of interest in order to fully understand the mecanisms involved in cirrhosis related hyponatremia, its prognostic value and clinical implications.

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Diagnosis and Management of Cirrhosis-Related Osteoporosis

BioMed Research International ◽

10.1155/2016/1423462 ◽

2016 ◽

Vol 2016 ◽

pp. 1-12 ◽

Cited By ~ 23

Author(s):

Lívia Alves Amaral Santos ◽

Fernando Gomes Romeiro

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Liver Transplantation ◽

Primary Biliary Cirrhosis ◽

Biliary Cirrhosis ◽

Immunosuppressant Therapy ◽

Treatment Of Osteoporosis ◽

Screening Strategies ◽

Cirrhotic Patients

Management of cirrhosis complications has greatly improved, increasing survival and quality of life of the patients. Despite that, some of these complications are still overlooked and scarcely treated, particularly those that are not related to the liver. This is the case of osteoporosis, the only cirrhosis complication that is not solved after liver transplantation, because bone loss often increases after immunosuppressant therapy. In this review, the definitions of bone conditions in cirrhotic patients are analyzed, focusing on the more common ones and on those that have the largest impact on this population. Risk factors, physiopathology, diagnosis, screening strategies, and treatment of osteoporosis in cirrhotic patients are discussed, presenting the more striking data on this issue. Therapies used for particular conditions, such as primary biliary cirrhosis and liver transplantation, are also presented.

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