Introduction: Hypernatremia is quite common in deceased liver donors. It has been suggested that donor hypernatremia results in exacerbation of reperfusion mediated injury in recipient. Uncorrected hypernatremia has been associated with poor graft functions or patient survival in at least four studies.. But there are few studies that indicate high serum sodium level in donor has little effect in outcome of liver transplant recipient. In our case report we came across with serum sodium as high as 198 meq/l in donor. In addition, a literature review revealed no previous reports of dealing with hypernatremia as high as 198 meq/l in donor.

Case Report: Here we report two cases of deceased donor with very high serum sodium level. . In Case 1, donor was brought in emergency with complaint of drowsiness and weakness. Brain CT without contrast indicated cerebellar tumor with brainstem compression. Serum sodium level was 198 meq/l. Recipient was a case of alcoholic liver cirrhosis and hepatocellular carcinoma. In Case 2, donor was a case of basal ganglia hemorrhage with mass effect and midline deviation. Serum sodium was 172 meq/l. Recipient was a case of HBV related end stage liver disease. In both cases standard operative techniques were used. Anesthesia protocol was followed as usual. Postoperative care was done accordingly. There was uneventful recovery in both cases. Graft performance was measured from liver functions tests specially ALT and serum bilirubin level. At the same time serum creatinine was also assessed throughout hospital stay. Both patients remained stable till discharge and are in contact with the hospital for their routine follow up.

Discussion: In previous studies, deceased donors having serum sodium 170 meq/l were discussed. Management of these two cases indicates that hypernatremia as high as 198 meq/l in deceased donor, has almost no effect in outcome of liver transplant recipient. With the rising demand for liver transplantation and the shortage of organs, adaptation of extended criteria including donor hypernatremia will increase the donor pool. More research on this topic is recommended.