Introduction Brain death results in an impairment of cerebral regulatory pro- cesses often leading to an early depletion of anti-diuretic hor- mone and the development of central diabetes insipidus due to anterior and posterior pituitary failure. The clinical consequences are characterized by inappropriate diuresis, severe hypovolemia, hyperosmolality and serum sodium levels ranging above normal values [1, 2]. Elevated donor serum sodium levels have been identified as an independent risk factor for early allograft dysfunction by several groups in the field of liver transplantation [3 – 6], while other groups state that there is no correlation between hypernatremia and outcome of transplanted patients [7]. Totsuka et al. reported that recipients of hepatic allografts from donors with uncor- rected elevated sodium levels above 155 mEq/L had a signifi- cantly greater incidence of early graft loss, while detrimental ef- Abstract Background: Elevated donor serum sodium is a phenomenon often encountered in the management of brain dead donors. The clinical relevance on recipient outcome is less examined. We investigated the impact of elevated donor serum sodium lev- els (DSL) on outcome after heart transplantation in 1800 heart transplantations. Methods: Data was conducted in a retrospec- tive analysis from 1989 until 2005. The transplantations were performed at three German heart transplant centers. The joined database included DSL at the time of organ procurement, recipi- ent and donor age, ischemia time, primary graft failure and sur- vival data. Results: Mean DSL was 147.7±10.3 l/l (range 111– 208 l/l). Recipients were divided into 4 groups with percentiles of 141, 147, and 154l/l resulting in DSL of A: 135.8±4.4, B: 143.6 ±1.7, C: 149.7 ±1.9, and D: 161.3±7.7 l/l for the four quar- tiles. Primary graft failure ocurred in 2.6 % of the patients with A: 2.8 %, B: 2.8 %, C: 3.7% and D: 1.4 % (p = n.s.). Mean 5- and 10-year- survival rates were 70.9% (57.6%) with A: 71.1% (53.86 %), B: 69.3 % (53.9 %), C: 72.7 % (61.0%), D: 71.2% (62.4 %), respectively (p = n. s.). In a multivariate analysis a significant impact on postoperative re- sults could be revealed for recipient age (p = 0.002), ischemia time (p = 0.002) and donor age (p = 0.009). DSL were no individual risk factor in the multivariate analysis. Conclusion: There was no im- pact of donor serum sodium levels neither on early postoperative results, nor on long-term outcome indicating that cardiac allo- grafts from donors with elevated sodium levels might be trans- planted successfully, achieving favourable results. Key words Heart and lung transplantation · allocation · marginal donors Original Cardiovascular 313 Affiliation 1 Department of Cardiac Surgery, Ludwig-Maximilians-University, München, Germany 2 Department of Cardiothoracic Surgery, Heart Center North Rhine-Westphalia, Bad Oeynhausen, Germany 3 Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University, Jena, Germany Correspondence Ingo Kaczmarek · Department of Cardiac Surgery · Ludwig-Maximilians-University · Marchioninistraße 15 · 81377 München · Germany · Phone: + 49 89 7095 0 · Fax: + 49 89 7095 88 73 · E-mail: Ingo.Kaczmarek@med.uni-muenchen.de Received November 16, 2005 Bibliography Thorac Cardiov Surg 2006; 54: 313–316 © Georg Thieme Verlag KG · Stuttgart · New York · DOI 10.1055/s-2006-923889 · ISSN 0171-6425 I. Kaczmarek 1 G. Tenderich 2 J. Groetzner 3 M.-A. Deutsch 1 U. Schulz 2 A. Beiras-Fernandez 1 B. Meiser 1 T. Wahlers 3 R. Koerfer 2 B. Reichart 1 The Controversy of Donor Serum Sodium Levels in Heart Transplantation – A Multicenter Experience Downloaded by: Herz- und Diabeteszentrum NRW. Copyrighted material.