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Short-Term, Low-Dose Use of Tolvaptan as a Bridge Therapy to Expedite Liver Transplant for Severe Hyponatremic, Cirrhotic Patients With High Model for End-Stage Liver Disease Scores
- Source :
- Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 15(6)
- Publication Year :
- 2015
-
Abstract
- For patients on liver transplant waiting lists, hyponatremia is associated with increased mortality before transplant and complications during the early posttransplant period. Conventional therapies, such as fluid restriction or hypertonic saline infusion, are of limited value. We describe 2 patients with high Model for End-Stage Liver Disease scores (30) who were referred to our unit for expedited liver transplant. While on waiting lists, these patients developed severe hyponatremia (125 mEq/L) that was refractory to conventional therapies. Low-dose, short-term tolvaptan therapy (15 mg/d for 5 d) was then administered, as a bridge therapy to transplant, resulting in prompt restoration of serum sodium levels without any major clinical event. One patient died a few days later as no suitable grafts were available. The other received a liver transplant, and the outcome was uneventful. In conclusion, our report demonstrates that a short-term, low-dose tolvaptan-based strategy promptly resolves hyponatremia in patients who are on expedited waiting lists for liver transplant, allowing surgery with improved sodium levels and possibly limiting peritransplant complications.
- Subjects :
- Liver Cirrhosis
Male
Settore MED/12 - Gastroenterologia
Time Factors
Waiting Lists
Benzazepines
Middle Aged
Severity of Illness Index
Drug Administration Schedule
Decision Support Techniques
Liver Transplantation
Fatal Outcome
Treatment Outcome
Tolvaptan
Humans
Antidiuretic Hormone Receptor Antagonists
Hyponatremia
Subjects
Details
- ISSN :
- 21468427
- Volume :
- 15
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation
- Accession number :
- edsair.pmid.dedup....74375c38467e1d3516d77af7b64699e5