To evaluate the safety and therapeutic effect of liver graft from donors of varying degree hypernatremia in split liver transplantation (SLT) patients.

Clinical data of122 consecutive donor-recipients undergoing SLT in the Third Affiliated Hospital of Sun Yat-sen University from September 2017 to January 2022 were analyzed retrospectively. The informed consents of all donors, recipients or (and) their families were obtained and the local ethical committee approval was received. All the liver grafts were from donation after citizen death. Among the donors, 97 cases were male and 25 female, aged 4.6-56.8 years, with a median of 27.3 years. Among the recipients, 85 cases were male and 37 female, aged 0.2-82.8 years, with a median of 8.0 years. After strict screening and matching of donors and recipients, the donors with stable circulation were selected. The cold ischemia time (CIT) was shortened as much as possible (≤8 h). The liver grafts, which were soft and with no or slight fatty change (<10%), were chosen. The perfusion process of liver grafts was optimized. According to the donors' serum sodium level, the recipients were divided into the hypernatremia group (160 mmol/L≤donor serum sodium level<170 mmol/L, n=22) and control group (donor serum sodium level <160 mmol/L, n=100). The CIT and intraoperative blood loss between two groups were compared by rank-sum test. The incidence of early graft dysfunction within postoperative 7 d and 30 d mortality were statistically analyzed by Chi-square test. The 90 d cumulative survival after SLT was statistically compared by Kaplan-Meier method and Log-rank test.

The median CIT and intraoperative blood loss in the hypernatremia group were 445(360, 514) min, 700(300,1 500) ml, respectively, and were 450(360, 510) min, 500(200, 1 200) ml in the control group, no significant difference was observed between two groups (Z=-0.182, 0.448; P>0.05). The incidence of early graft dysfunction within postoperative 7 d in the hypernatremia and control groups were 36%(8/22) and 40% (10/100) respectively, and the 30-d mortality were 5%(1/22) and 6%(6/100) respectively, and no significant difference was observed between two groups (χ²=0.100, 0.071; P>0.05). The 90 d cumulative survival after SLT in the hypernatremia and control groups were 90.9% and 93.0% respectively, and no significant difference was observed between two groups in the postoperative survival (χ²=0.014, P>0.05).

Liver grafts from donors with serum sodium level <160 mmol/L can be applied in SLT. For donors with 160 mmol/L≤serum sodium level <170 mmol/L, SLT can be also performed with caution through strict assessment and selection of fatty liver, control of CIT and optimization of perfusion process.