title: Intraoperative hyperkaliemia complicating hand-assisted live-donor nephrectomy.
abstract: OBJECTIVE
  Live donation has become increasingly valuable as a potential source of kidneys for transplant with hand-assisted laparoscopic donation is an important method of organ procurement. An important consideration is adequate preoperative and intraoperative planning, and precautions to minimize potential risks in the donor while providing a graft with good primary function.
  
  
  METHODS
  We present a case of live donation in which a hand-assisted laparoscopic approach was used to facilitate kidney donation. The process was complicated by a period of profound intraoperative hyperkalaemia, subsequently ascribed to rhabdomyolysis owing to muscle necrosis.
  
  
  RESULTS
  A 46-year-old man underwent assessment for live kidney donation for his brother. Preoperative investigations revealed normal renal function with no contraindications to donation. However, at the time of donation, a period of unexplained hyperkalaemia occurred that resolved spontaneously with fluid resuscitation and aggressive diuresis. After surgery, he was demonstrated to have an elevated creatine kinase level associated with unilateral gluteal pain and bruising. There were no long-term complications, and the donor made a full recovery with normal renal function. Hyperkalaemia was ascribed to extensive rhabdomyolysis owing to positioning on the operating table at the time of surgery.
  
  
  CONCLUSIONS
  Rhabdomyolysis associated with laparoscopic renal surgery requires prompt recognition and treatment while unexplained hyperkalaemia may herald its onset. It is important that an increased sense of vigilance is given to patients with increased muscularity or body mass, especially in donor nephrectomy patients, because of its effect on the remaining solitary kidney.
authors.affiliation: Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: van Dellen
authors.forename: Afshin
authors.initials: A
authors.lastname: Tavakoli
authors.forename: Richard
authors.initials: R
authors.lastname: Wadsworth
authors.forename: Titus
authors.initials: T
authors.lastname: Augustine
mesh_terms: D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects*; D006801:Humans; D006947:Hyperkalemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007432:Intraoperative Period; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D056888:Patient Positioning; D012206:Rhabdomyolysis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome