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Volume: 12 Issue: 2 April 2014


Response to Letter to the Editor: Early Outcomes of Liver Transplants in Patients Receiving Organs From Hypernatremic Donors

Dear Editor:

Thank you for your attention to our article.1 Regarding the questions, we would like to bring to your attention the following comments:

In many papers, the maximum value for moderate-to-severe hypernatremia is equal to or greater than 155 mEq/L.2-6 We focused on terminal hypernatremia because despite conventional treatment of hypernatremic donors in the intensive care unit, there was no change in values for sodium in these patients; thus, according to the value of the terminal hypernatremia, a definite diagnosis was given. Regarding the other question, Kwiatkowska7 and associates have reported long-term renal functions in a group of renal transplant recipients. However, our study is about early outcomes in liver transplant recipients, and it has been shown that the Model for End-Stage Liver Disease score (international normalized ratio and creatinine) is effective for early postoperative liver function.8 On the other hand, in accord with our experiences at this center, the postoperative condition of renal function is clearly associated with liver function.


  1. Khosravi MB, Firoozifar M, Ghaffaripour S, Sahmeddini MA, Eghbal MH. Early outcomes of liver transplants in patients receiving organs from hypernatremic donors. Exp Clin Transplant. 2013;11(6):537-540.
    CrossRef - PubMed
  2. Kolmodin L, Sekhon MS, Henderson WR, Turgeon AF, Griesdale DE. Hypernatremia in patients with severe traumatic brain injury: a systematic review. Ann Intensive Care. 2013;3(1):35.
    CrossRef - PubMed
  3. Alshayeb HM, Showkat A, Babar F, Mangold T, Wall BM. Severe hypernatremia correction rate and mortality in hospitalized patients. Am J Med Sci. 2011;341(5):356-360.
    CrossRef - PubMed
  4. Briceño J, Pera-Rojas C, Solorzano G, De la Mata M, Pera-Madrazo C. Use of high-risk liver donors for urgent and elective liver transplantation. Transplant Proc. 1999;31(1-2):440-442.
    CrossRef - PubMed
  5. Kazemeyni SM, Esfahani F. Influence of hypernatremia and polyuria of brain-dead donors before organ procurement on kidney allograft function. Urol J. 2008;5(3):173-177.
  6. 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.
    CrossRef - PubMed
  7. Kwiatkowska E, Bober J, Ciechanowski K, Kedzierska K, Golmbiewska E. Increased serum sodium values in brain-dead donor's influences its long-term kidney function. Transplant Proc. 2013;45(1):51-56.
    CrossRef - PubMed
  8. Wagener G, Raffel B, Young AT, Minhaz M, Emond J. Predicting early allograft failure and mortality after liver transplantation: the role of the postoperative model for end-stage liver disease score. Liver Transpl. 2013;19(5):534-542.
    CrossRef - PubMed

Volume : 12
Issue : 2
Pages : 170 - 170
DOI : 10.6002/ect.2014.0009

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From the Department of Anesthesiology and Critical Care, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
Acknowledgements: The authors have no conflicts of interest to declare, and they received no funding for the study.
Corresponding author: Mohammad Firoozifar, MD, Fellowship in Anesthesia for Organ Transplantation, Shiraz University of Medical Sciences, Department of Anesthesiology and Critical Care, Anesthesiology and Critical Care Research Center, Nemazi Hospital, Shiraz, Iran Mohammad Firoozifar, Department of Anesthesiology and Critical Care, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
Phone: +98 917 316 7678
Phone: +98 71 1230 8072
E-mail: or