Predictors of hyperkalemia in the prereperfusion, early postreperfusion, and late postreperfusion periods during adult liver transplantation.
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+ > or =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.
Xia
Victor W
VW
Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1778, USA. vxia@mednet.ucla.edu
Ghobrial
Rafik M
RM
Du
Bin
B
Chen
Tabitha
T
Hu
Ke-Qin
KQ
Hiatt
Jonathan R
JR
Busuttil
Ronald W
RW
Steadman
Randolph H
RH
D000328:Adult; D000367:Age Factors; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000652:urine; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects; D011188:Potassium / Q000097:blood*; D012042:Registries; D015424:Reperfusion; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D052096:Warm Ischemia / Q000009:adverse effects
D003404:Creatinine; D011188:Potassium