Hypernatremia is a common condition in brain-dead patients, and its correction is a key point in their conditioning as organ donors. Controlling it poses a challenge for medical professionals, and it is believed to impact liver graft function. The purpose of this review is to summarize the available results describing the relationship between hypernatremia in brain-dead organ donors and the success of liver transplantation. It is believed that it can lead to a high incidence of liver graft rejection. Other studies have shown that donor serum sodium levels do not affect clinical outcomes. There is a lack of definitive literature data fully supporting one of these two theses.
Cuzzo B, Padala SA, Lappin SL. Physiology, Vasopressin. In: StatPearls. StatPearls Publishing; 2023. Accessed August 31, 2023. http://www.ncbi.nlm.nih.gov/books/NBK526069/
Cywinski JB, Mascha E, Miller C, et al. Association between donor-recipient serum sodium differences and orthotopic liver transplant graft function. Liver Transpl. 2008;14(1):59-65. doi:10.1002/lt.21305
Dictus C, Vienenkoetter B, Esmaeilzadeh M, Unterberg A, Ahmadi R. Critical care management of potential organ donors: our current standard. Clin Transplant. 2009;23 Suppl 21:2-9. doi:10.1111/j.1399-0012.2009.01102.x
Ennis KM, Brophy GM. Management of intracranial hypertension: focus on pharmacologic strategies. AACN Adv Crit Care. 2011;22(3):177-182; quiz 183-184. doi:10.1097/NCI.0b013e318214564b
Everson GW. MANNITOL. In: Olson KR, Anderson IB, Benowitz NL, et al., eds. Poisoning & Drug Overdose. 7th ed. McGraw-Hill Education; 2018. Accessed August 31, 2023. accessmedicine.mhmedical.com/content.aspx?aid=1174607485
Figueras J, Busquets J, Grande L, et al. The deleterious effect of donor high plasma sodium and extended preservation in liver transplantation. A multivariate analysis. Transplantation. 1996;61(3):410-413. doi:10.1097/00007890-199602150-00016
González FX, Rimola A, Grande L, et al. Predictive factors of early postoperative graft function in human liver transplantation. Hepatology. 1994;20(3):565-573. doi:10.1002/hep.1840200304
Huang X, Yang L, Ye J, He S, Wang B. Equimolar doses of hypertonic agents (saline or mannitol) in the treatment of intracranial hypertension after severe traumatic brain injury. Medicine (Baltimore). 2020;99(38):e22004. doi:10.1097/MD.0000000000022004
Issac E, Venugopalan S. Pathophysiology of brain stem death. Amrita Journal of Medicine. 2020;16(2):50. doi:10.4103/AMJM.AMJM_32_20
Katzung BG, Vanderah TW. Basic & Clinical Pharmacology. McGraw Hill’s AccessScience. Published 2021. Accessed August 31, 2023. https://www.accessscience.com/content/book/9781260452310
Mangus RS, Fridell JA, Vianna RM, et al. Severe hypernatremia in deceased liver donors does not impact early transplant outcome. Transplantation. 2010;90(4):438-443. doi:10.1097/TP.0b013e3181e764c0
Marino PL. Marino’s the ICU Book. Fourth edition. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. Accessed August 31, 2023. http://solution.lww.com/access
Mason A, Malik A, Ginglen JG. Hypertonic Fluids. In: StatPearls. StatPearls Publishing; 2023. Accessed August 31, 2023. http://www.ncbi.nlm.nih.gov/books/NBK542194/
McDonald MF, Barrett SC, Malik TH, et al. Elevated serum sodium in recipients of liver transplantation has a substantial impact on outcomes. Transpl Int. 2021;34(10):1971-1983. doi:10.1111/tri.13968
Noda M, Hiyama TY. Sodium sensing in the brain. Pflugers Arch. 2015;467(3):465-474. doi:10.1007/s00424-014-1662-4
Optimal Dose and Concentration of Hypertonic Saline in Traumatic Brain Injury: A Systematic Review - PubMed. Accessed August 31, 2023. https://pubmed.ncbi.nlm.nih.gov/35735001/
Shemie SD, Dhanani S. The Physiology of Brain Death and Organ Donor Management. Pediatric Critical Care Medicine. Published online January 28, 2014:497-518. doi:10.1007/978-1-4471-6362-6_38
Tector AJ, Mangus RS, Chestovich P, et al. Use of Extended Criteria Livers Decreases Wait Time for Liver Transplantation Without Adversely Impacting Posttransplant Survival. Ann Surg. 2006;244(3):439-450. doi:10.1097/01.sla.0000234896.18207.fa
Totsuka E, Dodson F, Urakami A, et al. Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia. Liver Transpl Surg. 1999;5(5):421-428. doi:10.1002/lt.500050510
Totsuka E, Fung U, Hakamada K, et al. Analysis of clinical variables of donors and recipients with respect to short-term graft outcome in human liver transplantation. Transplant Proc. 2004;36(8):2215-2218. doi:10.1016/j.transproceed.2004.08.052
Yoshikawa MH, Rabelo NN, Welling LC, Telles JPM, Figueiredo EG. Brain death and management of the potential donor. Neurol Sci. 2021;42(9):3541-3552. doi:10.1007/s10072-021-05360-6
Zhou ZJ, Chen GS, Si ZZ, et al. Prognostic factors influencing outcome in adult liver transplantation using hypernatremic organ donation after brain death. Hepatobiliary Pancreat Dis Int. 2020;19(4):371-377. doi:10.1016/j.hbpd.2020.06.003