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Ascites, sodium level increased mortality for children awaiting liver transplantation

The presence of ascites and serum sodium variables among pediatric cirrhotic patients reduced survival rates within 90 days after inclusion on a liver transplantation wait list, according to recent study results.

Researchers analyzed 522 patients (mean age, 20.1 months; 56% female) with cirrhosis on a liver transplant wait list between October 2000 and February 2012. Sixty-six percent of patients (n=345) were aged younger than 12 months, and 40% (n=208) of the entire cohort showed ascites. Seventy-nine percent of patients with hyponatremia presented ascites.

Variables measured included: age, sex, diagnosis, presence of ascites, spontaneous bacterial peritonitis, Pediatric Endstage Liver Disease score (PELD) and ratio of serum sodium concentration.

According to Kaplan-Meier survival curves, patients with sodium levels greater than or equal to 135 mEq/L had a higher survival probability rate over 90 days compared with sodium levels less than 130 mEq/L, (P<.001). Patients without ascites had greater survival probability rate, compared with ascites patients (P<.001). Patients with ascites had a mortality rate of 19.7%, compared with 6.4% for those without ascites, 90 days after being listed for a liver transplant.

In multivariate analysis of pre-transplant variables, total bilirubin (HR=2.09; 95% CI, 1.35-3.21), international normalized ratio (HR=9.83; 95% CI, 4.51-21.45), serum sodium levels (HR=0.96; 95% CI, 0.92-0.99), ascites (HR=2.59; 95% CI, 1.44-4.64) and categorized age (0-1 year vs. older) (HR=2.33; 95% CI, 1.11-4.86) were associated with risk for mortality within 90 days.

“The presence of ascites and serum sodium concentration are important variables associated with decreased patient survival while candidates wait for a liver graft,” researchers concluded. “Further prospective multicenter studies are necessary to validate these findings in order to improve current allocation polices based on the PELD score.”

Disclosure: See the study for a full list of relevant financial disclosures.