Elevated effluent potassium concentrations predict the development of postreperfusion hyperkalemia in deceased liver transplantation: a retrospective cohort study

Abstract

Background Postreperfusion hyperkalemia (PRHK) has garnered increasing attention in regard to deceased liver transplantation (LT), especially for LT using the expanded criteria donor grafts. However, the impact of the effluent potassium (eK+) concentration on PRHK has been largely overlooked. We evaluated whether elevated eK+ concentrations are associated with PRHK in deceased LT. Methods In this single-institution, retrospective cohort study, we included all adults who underwent deceased LT with intraoperative eK+ concentration monitoring between November 2016 and December 2018. The eK+ concentrations were obtained from the effluent samples collected following a standard portal vein flush. PRHK was defined as any serum potassium (sK+) level of > 5.5 mmol/L following reperfusion. Logistic regression was performed to identify predictors for PRHK, and linear regression was used to examine predictors of the maximum percentage increase in the sK+ level following reperfusion. Results Of the 86 patients who met the inclusion criteria, 54 (62.8%) developed PRHK. Independent predictors for PRHK included greater graft weight (OR 1.283 [95% CI 1.029–1.599] per 100 g, P = 0.027), an elevated eK+ concentration (OR 1.291 [95% CI 1.068–1.561] per mol/L, P = 0.008), and a higher sK+ level before reperfusion (OR 4.459 [95% CI 1.543–12.884] per mol/L, P = 0.006). An eK+ concentration of more than 6.9 mmol/L had a sensitivity of 59.26% and a specificity of 78.12% for predicting PRHK (area under the receiver operating characteristic curve, 0.694). Multiple linear regression analyses indicated that the eK+ and sK+ levels before reperfusion were significant predictors of the maximum percentage increase in the sK+ level following reperfusion. In addition, PRHK was associated with an increased risk of postreperfusion significant arrhythmias, severe postreperfusion syndrome, and postoperative early allograft dysfunction. Conclusions This study shows that the eK+ concentration could predict the risk of PRHK in deceased LT. Further prospective studies are warranted to clarify these associations.

Prediction, prevention, and treatment of post reperfusion syndrome in adult orthotopic liver transplant patients

“…Higher donor BMI was significantly associated with PRS in a study by Bekki et al., where the PRS group had an average donor BMI almost 2 kg/cm 2 higher than the non‐PRS group 17 . Similarly, larger graft weight was associated with development of post‐reperfusion hyperkalemia in a study by Zhang et al 24 …”

“…Higher donor BMI was significantly associated with PRS in a study by Bekki et al, where the PRS group had an average donor BMI almost 2 kg/cm 2 higher than the non-PRS group. 17 Similarly, larger graft weight was associated with development of post-reperfusion hyperkalemia in a study by Zhang et al 24 Kim et al found that underlying autonomic tone in transplant recipients played a role in the development of PRS. 20 In this study of 218 patients, they performed frequency domain analysis of heart rate variability which they utilize as a reflection of autonomic tone.…”

“…5,7 A second database search using the same criteria occurred at a later date and yielded 10 additional studies that met inclusion criteria, making the final number of selected studies 18. [15][16][17][18][19][20][21][22][23][24] Figure 1 shows a PRISMA diagram detailing the selection process.…”

Could retrograde reperfusion combined with washout technique broaden the applicability of marginal grafts in liver transplantation? Intra-operative and short-term outcomes of a prospective cohort

“…However, the HTK solution has a relatively low potassium concentration compared to other preservative solutions employed in the transplant. The systemic spread of cytokines and eicosanoids can also be minimized by this technique 14 .…”

Prophylactic terlipressin infusion for severe postreperfusion syndrome in patients undergoing deceased donor liver transplantation. The TIPS-DDLT randomized controlled trial

“…PRS was initially described as cardiovascular collapse following graft reperfusion during LT and was defined as a greater than 30% reduction in mean arterial pressure (MAP) relative to the baseline value within 5 min of reperfusion that lasts for at least 1 min 9 . The concept of severe PRS 6 – 8 , 10 – 12 has emerged since the increased utilization of expanded criteria donor (ECD) grafts worldwide, focusing on severe hyperkalemia 13 , 14 , significant arrhythmias 10 , refractory hypotension 10 – 12 , and even cardiac arrest 10 , 15 , 16 .…”