Potassium levels after liver reperfusion in adult patients undergoing cadaveric liver transplantation: A retrospective cohort study

Laurence Weinberg, Dong Kyu Lee, Anoop Ninan Koshy, Kai Wen Leong, Shervin Tosif, Ruth Shaylor, Param Pillai, Lachlan Fraser Miles, Alexandra Drucker, Brett Pearce

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Hyperkalemia is a common cause of arrhythmias in patients undergoing liver transplantation. We examined the pattern of change of potassium levels during and immediately after reperfusion of the donor liver. Materials and methods: Potassium levels of 30 consecutive adult patients undergoing cadaveric liver transplantation were assessed before and after liver reperfusion. Changes in potassium levels over 13 predefined timepoints were analyzed. Primary aim: to describe the pattern of change of potassium levels during the reperfusion period. Correlation between changes in potassium levels during reperfusion and a-priori variables were investigated. Results: Baseline median (IQR) potassium levels were 4.1 (3.8:4.5) mmol/L. Thirteen patients (43%) developed hyperkalemia, 10 (33%) of whom developed severe hyperkalemia. Potassium levels peaked at 80 s post reperfusion, plateaued until 2 min, before returning toward baseline values at 5 min. There was a strong association between pre-reperfusion/baseline potassium levels and peak potassium values during reperfusion (95%CI: 0.26 to 0.77, p < 0.001). A baseline potassium level of 4.45 mmol/L was a good predictor of reperfusion hyperkalemia with a sensitivity of 69.2% and specificity of 94.1% (AUC = 0.894, 95%CI: 0.779 to 1.000, p < 0.001). Conclusion: Hyperkalemia during cadaveric liver transplantation is common affecting almost 1 in 2 patients during reperfusion. During reperfusion potassium levels peaked within 2 min and over a third of patients developed severe hyperkalemia. Higher peak potassium levels correlated strongly with higher pre-reperfusion potassium values. These findings guide clinicians with timing of sampling of blood to check for hyperkalemia and identify modifiable factors associated with the development of hyperkalemia.

Original languageEnglish
Pages (from-to)111-118
Number of pages8
JournalAnnals of Medicine and Surgery
Volume55
DOIs
Publication statusPublished - 2020 Jul

Keywords

  • Anesthesia
  • Liver transplantation
  • Potassium
  • Reperfusion

ASJC Scopus subject areas

  • Surgery

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