Predictive Risk Factors in the Development of Intraoperative Hyperkalemia in Adult Living Donor Liver Transplantation

Hyperkalemia in liver transplantation

Hyperkalemia commonly occurs in patients undergoing liver transplantation. The intraoperative course of liver transplant often involves hemodynamic and metabolic derangements leading up to liver reperfusion. Potassium levels can rise to dangerous levels immediately after reperfusion. The consequences of intraoperative hyperkalemia include risk of malignant arrhythmias and cardiac arrest. This review explores the numerous causes of hyperkalemia, including contributing surgical and anesthetic factors. The authors also discuss various treatment options and surgical techniques to manage perioperative hyperkalemia. It is important for anesthesiologists to understand the implications and management of hyperkalemia to optimize patients and reduce the risk of an intraoperative cardiac arrest.

Changes in Blood Potassium after Reperfusion during Living-Donor Liver Transplantation: An Exploratory Study

The incidence of hyperkalemia (>5.5 mEq/L) or high blood potassium (5–5.5 mEq/L) during living-donor liver transplantation (LDLT) is reported to be more than 10%. It occurs more frequently in the early post-reperfusion period and is a major cause of post-reperfusion arrhythmia and cardiac arrest. Unlike deceased-donor liver transplantation, the pattern of blood potassium changes immediately after reperfusion has not been described in LDLT. From January 2021 to March 2021, fifteen consecutive patients were enrolled. Baseline blood potassium was measured from blood samples obtained 10-min (T_-10) and immediately before (T₀) reperfusion. During the first 5 min after reperfusion, blood potassium measurements were conducted every one minute (T₁–T₅). The blood potassium levels at T_-10 and T₀ were 3.8 ± 0.4 and 3.9 ± 0.4 mEq/L, respectively. After reperfusion, mean increases (95% CI) in blood potassium from T_-10 and T₀ were 0.5 (0.4–0.6) and 0.4 (0.3–0.5) mEq/L, respectively. Blood potassium peaked at T₁, returned to baseline at T₃, and fell below the baseline at T₅. Peak blood potassium after reperfusion showed strong correlations with blood potassium measured at T_-10 (p < 0.001) and T₀ (p < 0.0001). These findings can support the establishment of future research plans and perioperative management of blood potassium in LDLT.

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

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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Hyperkalemia during the reperfusion phase of cadaveric liver transplantation is common.

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Potassium levels peaked at 80 s post reperfusion, plateaued for 2 min, and returned to baseline at 5 min.

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There was a strong association between pre-reperfusion potassium levels and peak potassium values during reperfusion.

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Timing of blood sampling to check for hyperkalemia is paramount.

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A baseline potassium level of greater than 4.45 mmol/L was a good predictor of reperfusion hyperkalemia.

Rat liver and kidney post-mitochondrial dysfunction by addition of chronic mixed metal intoxication and hepatorenal wellness mediated by phenolic components from Croton zambiscus leaves

Chronic exposure of mixed-metal intoxication has been associated with prolonged oxidative stress and severe hepatorenal damage. This present study demonstrates the hepatoprotective and renoprotective activity of Croton zambesicus (C-ZAMB) leaves, naturally occurring phenolic compounds against chronic mixed-metal (EOMABRSL) induced toxicity. 0.5 ml of EOMABRSL via oral route induced chronic hepatoxicity and nephrotoxicity on exposure for 98 days (non-withdrawal) and 70 days (withdrawal) by abnormal alteration in the levels of endogenous antioxidants. Moreover, EOMABRSL induced hepatorenal damage by increasing the markers of liver toxicity (ALT, AST, ALP, GGT and bilirubin) and kidney failure (creatinine, urea, uric acid, and renal electrolytes-Na⁺ and K⁺). Both non-withdrawal and withdrawal approaches of EOMABRSL-exposed animals exhibited hepatorenal dysfunctions by increasing the activity of eco-5¹-nucleotidase (5¹ENT) followed by the decreased in the activity of lactate dehydrogenase (LDH)-index of cellular ATP. These results were further supported by the histopathological examination of nephritic cells, hepatocytes and splenocytes, manifested by hepatocellular necrosis, swelling or degeneration of tubular kidney epithelial cells as well as coalescing splenic periarteriolar lymphoid sheaths (PALSs) and lymphoid haemosiderin. The chronic EOMABRSL intoxication was ameliorated by administration of phenolic antioxidants from C-ZAMB leaves. Therefore, our study supports the view that phenolic C-ZAMB leaves may mediate hepatorenal wellness on chronic exposure to mixed-metal intoxication.