Weinberg Laurence, Lee Dong-Kyu, Koshy Anoop Ninan, Leong Kai Wen, Tosif Shervin, Shaylor Ruth, Pillai Param, Miles Lachlan Fraser, Drucker Alexandra, Pearce Brett
Austin Health, Victoria, Australia.
Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia.
Ann Med Surg (Lond). 2020 May 16;55:111-118. doi: 10.1016/j.amsu.2020.05.002. eCollection 2020 Jul.
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.
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.
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).
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.
高钾血症是肝移植患者心律失常的常见原因。我们研究了供肝再灌注期间及之后即刻血钾水平的变化模式。
对30例连续接受尸体肝移植的成年患者在肝再灌注前后的血钾水平进行评估。分析了13个预先定义时间点的血钾水平变化。主要目的：描述再灌注期间血钾水平的变化模式。研究再灌注期间血钾水平变化与先验变量之间的相关性。
基线血钾水平中位数（四分位间距）为4.1（3.8：4.5）mmol/L。13例患者（43%）发生高钾血症，其中10例（33%）发生严重高钾血症。血钾水平在再灌注后80秒达到峰值，在2分钟内保持稳定，然后在5分钟时恢复至基线值。再灌注前/基线血钾水平与再灌注期间血钾峰值之间存在强关联（95%CI：0.26至0.77，p<0.001）。基线血钾水平为4.45 mmol/L是再灌注性高钾血症的良好预测指标，敏感性为69.2%，特异性为94.1%（AUC=0.894，95%CI：0.779至1.000，p<0.001）。
尸体肝移植期间高钾血症很常见，在再灌注期间几乎每2例患者中就有1例受影响。再灌注期间血钾水平在2分钟内达到峰值，超过三分之一的患者发生严重高钾血症。更高的血钾峰值水平与更高的再灌注前血钾值密切相关。这些发现为临床医生提供了指导，有助于确定检查高钾血症的采血时间，并识别与高钾血症发生相关的可改变因素。
