Potassium levels after liver reperfusion in adult patients undergoing cadaveric liver transplantation: A retrospective cohort study
AuthorWeinberg, L; Lee, D-K; Koshy, AN; Leong, KW; Tosif, S; Shaylor, R; Pillai, P; Miles, LF; Drucker, A; Pearce, B
Source TitleAnnals of Medicine and Surgery
PublisherELSEVIER SCI LTD
University of Melbourne Author/sPearce, Brett; Weinberg, Laurence; Miles, Lachlan Fraser; Koshy, Anoop
AffiliationSurgery (Austin & Northern Health)
Document TypeJournal Article
CitationsWeinberg, L., Lee, D. -K., Koshy, A. N., Leong, K. W., Tosif, S., Shaylor, R., Pillai, P., Miles, L. F., Drucker, A. & Pearce, B. (2020). Potassium levels after liver reperfusion in adult patients undergoing cadaveric liver transplantation: A retrospective cohort study. ANNALS OF MEDICINE AND SURGERY, 55, pp.111-118. https://doi.org/10.1016/j.amsu.2020.05.002.
Access StatusOpen Access
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.
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