Hyponatremia increases mortality in pediatric patients listed for liver transplantation

Rebecca G. Carey, John C. Bucuvalas, William F. Balistreri, Todd G. Nick, Frederick R. Ryckman, Nada Yazigi

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


To evaluate hyponatremia as an independent predictor of mortality in pediatric patients with end-stage liver disease listed for transplantation. We performed a single-center retrospective study of children listed for liver transplantation. We defined hyponatremia as a serum sodium concentration <130 mEq/L that persisted for at least seven days. The primary outcome was death on the waiting list. Ninety-four patients were eligible for the study. The prevalence of hyponatremia was 26%. Kaplan-Meier survival analysis demonstrated that patients with hyponatremia had decreased pretransplant survival compared with patients who maintained a serum sodium >130 mEq/L (p < 0.001). Univariable association analyses demonstrated death on the waiting list was also associated with higher median PELD scores at listing (p = 0.01), non-white race (p = 0.02), and age <1 yr (p = 0.001). Logistic regression analysis identified hyponatremia and non-white race as independently associated with pretransplant mortality [OR = 8.0 (95% CI: 1.4-45.7), p = 0.02 and OR = 6.3 (95% CI: 1.25-33.3), p = 0.03]. When hyponatremia was added to the PELD score, it was significantly better in predicting mortality than the PELD score alone (c-statistic = 0.79, p = 0.03). Hyponatremia identifies a subset of pediatric patients with increased risk of pretransplant mortality and improves the predictive ability of the current PELD score.

Original languageEnglish
Pages (from-to)115-120
Number of pages6
JournalPediatric Transplantation
Issue number1
StatePublished - Feb 2010
Externally publishedYes


  • End-stage liver disease
  • Pediatric end-stage liver disease score
  • Race
  • Renal dysfunction
  • Transplant morbidity


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