LAUSR

The Organ Procurement and Transplant Network/ United Organ Sharing Network introduced the Model for End-Stage Liver Disease–sodium (MELD-Na) score for the allocation of liver grafts in 2016. As a result, the number of liver transplantation (LT) recipients who suffer from severe hyponatremia (<125 mEq/L) may increase. A rapid change in serum sodium can lead to osmotic demyelination syndrome (ODS). Patients undergoing LT with hyponatremia are at risk of developing complications of rapid sodium correction due to significant sodium loads received from intraoperative fluids and administered blood and blood products. Our center previously considered a serum sodium level of <125 mEq/L to be a relative contraindication to LT surgery. However, we acknowledged that these patients may subsequently become too ill and lose their transplant opportunity while waiting for a sodium correction. In the setting of severe hyponatremia, the benefit of proceeding with lifesaving LT surgery might outweigh the risk of posttransplant neurological complications. Therefore, intraoperative management should be fine-tuned to minimize rapid changes in serum sodium levels. Recently, continuous venovenous hemofiltration (CVVH) with dilutional methods of sodium correction has been described as an effective modality to manage severe hyponatremia, that allows for a gradual correction of hyponatremia. We attempted to use intraoperative CVVH to maintain a target serum sodium level by using diluted replacement fluid in 3 LT patients who had severe hyponatremia (<125 mEq/L) at the time of LT. In these 3 patients, we successfully managed serum sodium levels intraoperatively and postoperatively and prevented neurological complications and other significant postoperative morbidity. Retrospective collection and analysis of the transplant database were approved by the institutional review board at Henry Ford Hospital.