Hyperkalemia and liver transplantation

Abstract

Background: Hyperkalemia poses serious hazards to patients undergoing orthotopic liver transplantation (OLT), and its predictors have not been thoroughly examined. Methods: We retrospectively studied 1124 consecutive adult patients who underwent OLT. Hyperkalemia was defined as serum Kϩ Ͼ or ϭ5.5 mmol/L. A total of 47 recipient, donor, intraoperative, and laboratory variables were initially analyzed in univariate analyses. Independent predictors of hyperkalemia in three periods of OLT (prereperfusion, early postreperfusion, and late postreperfusion) were determined in multivariate logistic regression analyses. Results: Of 1124 patients, 10.2%, 19.1%, and 7.9% had hyperkalemia in the prereperfusion, early postreperfusion, and late postreperfusion periods, respectively. Higher baseline Kϩ and red blood cell transfusion were independent predictors of prereperfusion hyperkalemia. Higher baseline Kϩ (or prereperfusion Kϩ) and donation after cardiac death donor were independent predictors of early postreperfusion hyperkalemia. Higher baseline Kϩ, longer warm ischemia time, longer donor hospital stay, lower intraoperative urine output, and the use of venovenous bypass were independent predictors of late postreperfusion hyperkalemia. Conclusions: Several laboratory, intraoperative, and donor variables were identified as independent predictors of hyperkalemia in the different periods. Such information may be used for more targeted preemptive interventions in patients who are at risk of developing hyperkalemia during adult OLT. COMMENTSHyperkalemia has always been a problem in liver transplantation. Most concerns have been associated with severe hypotension, hypokalemia, and subsequent deaths in the reperfusion period. The occurrence of hyperkalemia in the period just following recirculation of blood during the liver transplant operation has been correlated with death. It has been thought that severe hyperkalemia may induce myocardial depression and the postreperfusion syndrome.2 Fukuzawa et al. 3 found a potassium concentration of 40 Ϯ 2 Meq/L in the first 100 mL of discarded blood following portal vein flush. These authors also observed that 500 mL of discarded blood contained 8.3 Ϯ 0.04 Meq, which was correlated with the graft liver weight. Washing out the potassium by flushing 500 mL of portal vein blood through the liver graft eliminated cardiac arrest due to severe hyperkalemia. 4 In contrast, Aggarwal et al.5 stated that hyperkalemia does not appear to be a major cause of reperfusion hypotension. Other investigators have reported that many factors other than hyperkalemia are involved with death in the postrecirculation period.6 Nakasuji and Bookallil 7 concluded that the occurrence of hyperkalemia after revascularization is correlated with serum potassium concentrations and metabolic acidosis due to insufficient cardiac output during the anhepatic phase. There have been several accounts of treating impending hyperkalemia with insulin infusion during the anhepatic phase. 8,9 In this article, Xia et al. r...

Potassium‐lowering effects of sodium zirconium cyclosilicate in the early post‐transplant period

“…[1][2][3] It is a recognized complication following solid organ transplantation, particularly in the early postoperative period among liver and kidney recipients. [4][5][6] This may result from factors such as altered renal function, use of immunosuppressive agents, and tissue injury. The decision regarding when to intervene following an elevated serum K+ is dependent on multiple patient factors such as history of coronary artery disease, arrythmias, and kidney function.…”

“…Hyperkalemia is a serious condition characterized by serum potassium (K+) levels above the upper limit of normal or 5 mEq/L, which can lead to life‐threatening complications such as cardiac arrhythmias 1–3 . It is a recognized complication following solid organ transplantation, particularly in the early postoperative period among liver and kidney recipients 4–6 . This may result from factors such as altered renal function, use of immunosuppressive agents, and tissue injury.…”

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

“…PRHK is associated with several intraoperative and postoperative complications, including but not limited to PRS, cardiac arrest, intraoperative death, and postoperative mortality [ 1 – 7 ]. Risk identification for PRHK is challenging, yet its prediction is the target of several investigations.…”

“…Postreperfusion hyperkalemia (PRHK) is a well-known and potentially life-threatening complication during liver transplantation (LT). PRHK may induce severe postreperfusion syndrome (PRS) [ 1 ], and its most serious consequence is cardiac arrest [ 1 – 7 ], which is associated with higher intraoperative mortality and poorer graft and patient survival after transplantation [ 4 – 7 ]. Therefore, identifying risk factors for PRHK, especially novel, modifiable predictors, may help clinicians develop targeted preventive strategies.…”

Salbutamol to facilitate management of acute hyperkalemia in liver transplantation: a case report

“…1,2 We describe a case of acute hyperkalemia that was provoked by acute hepatic necrosis during the pre-anhepatic stage in living donor liver transplantation (LDLT). Despite initial treatment, including calcium insulin and glucose, sodium bicarbonate, and furosemide, 3 hyperkalemia did not resolve until nebulized salbutamol was administered.…”