Dear Editor:

We read with great interest the article by Khosravi and associates¹ published in your journal in December 2013. In the literature, the effects of donor hypernatremia on postoperative graft loss have been investigated several times. The current article is interesting because it is the first study to investigate whether there is a difference between international normalized ratio values and renal functions of patients with normal and hypernatremic donor livers. No differences were found between hypernatremic donor and the others.

The authors classified donors as normal and hypernatremic according to target serum sodium level of 155 mEq/L. However, we have some questions: Why did the authors accept 155 as a cutoff for hypernatremia? This should be explained. In this study, only terminal serum sodium levels are indicated; there is no information about peak serum sodium levels or range. We believe that the statistical data regarding serum sodium levels are not satisfactory. The mean, median, and the highest and lowest levels of serum sodium are not defined. It would be better had the serum sodium levels been classified, as was done in the study by Mangus and associates.² In addition to liver functions, the authors studied renal functions in 2 groups. The effect of donor hypernatremia on graft functions in renal transplant patients has been investigated. Kwiatkowska and associates³ reported that long-term renal functions were disturbed in hypernatremic donor kidneys. In accordance with recent studies, no difference was found between the liver functions of the 2 groups. Although it is important that we study international normalized ratio values to evaluate liver functions, the clinical importance of studying renal functions is not indicated in this study.

References:

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.
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2. 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..
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3. Kwiatkowska E, Bober J, Ciechanowski K, Kȩdzierska K, Gołmbiewska E. Increased serum sodium values in brain-dead donor's influences its long-term kidney function. Transplant Proc. 2013;45(1):51-56.
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