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GENERAL ARTICLES

Predictors of Hyperkalemia in the Prereperfusion, Early Postreperfusion, and Late Postreperfusion Periods During Adult Liver Transplantation

Victor W. Xia, MD^*, Rafik M. Ghobrial, MD, Bin Du, MD^*, Tabitha Chen, BS^*, Ke-Qin Hu, MD, Jonathan R. Hiatt, MD, Ronald W. Busuttil, MD, PhD, and Randolph H. Steadman, MD^*

From the Departments of *Anesthesiology and Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Division of Gastroenterology, University of California, Irvine Medical Center, Orange, California; and Department of Anesthesiology, 2nd Affiliated Hospital, Kunming Medical College, Kunming, China.

Address correspondence and reprint requests to Victor W. Xia, MD, Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Box 951778, Los Angeles, CA 90095-1778. Address e-mail to vxia{at}mednet.ucla.edu.

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 K⁺ 5.5 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 K⁺ and red blood cell transfusion were independent predictors of prereperfusion hyperkalemia. Higher baseline K⁺ (or prereperfusion K⁺) and donation after cardiac death donor were independent predictors of early postreperfusion hyperkalemia. Higher baseline K⁺, 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.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999