Hyponatremia is prevalent before
liver transplantation and generally corrected immediately after
transplantation. However, the clinical significance of correction rate of
hyponatremia is not well investigated. The prognostic impact of pre-transplant serum
sodium concentrations and post-transplant correction rate of
hyponatremia were assessed. A total of 512 patients who received orthotopic
liver transplants were enrolled. The correction rate of
hyponatremia (delta
sodium, ΔNa) was calculated based on the data collected during the first 48 hours following
liver transplantation. Outcomes, including in-hospital mortality,
delirium, neurological complications,
acute kidney injury, and
infections, were compared according to the serum
sodium levels (sNa < 125, 125-135, and ≥ 135 mmol/L), and the risk factors for in-hospital mortality and neurological complications were analyzed using multivariate logistic regression methods. Patients with severe
hyponatremia (sNa < 125 mmol/L) had higher rates of in-hospital mortality (9.6%, P = 0.010),
delirium (54.8%, P = 0.003), neurological complications (24.7%, P = 0.003), and
acute kidney injury (57.5%, P = 0.005). In multivariate analysis, serum
sodium levels (OR = 0.975, P = 0.402) and delta
sodium (OR = 1.097, P = 0.066) were not independent risk factors for in-hospital mortality. However, delta
sodium (OR = 1.093, P = 0.003) and fast correction rate of
hyponatremia (ΔNa ≥ 12 mmol/L/24h, OR = 3.397, P = 0.023) were significantly associated with post-transplant neurological complications. Pre-
transplantation hyponatremia was not independently associated with clinical outcomes. However, rapid correction of
hyponatremia is an independent risk factor for the development of post-transplant neurological complications.