Boldaji Vida Naderi, Safarpour Ali Reza, Sahmeddini Mohammad Ali
Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
BMC Anesthesiol. 2025 Sep 2;25(1):444. doi: 10.1186/s12871-025-03234-4.
Liver transplantation (LT) is a well-known efficacious treatment for life-threatening liver diseases. This complicated surgery is significantly associated with morbidity and mortality. Hyperkalemia (a condition where the blood potassium level is ≥ 5 mEq/L) is a serious complication that occurs at all times during liver transplantation, but it happens more frequently within 5 min after reperfusion. Rapid changes in serum potassium levels have led anesthesiologists to predict the development of hyperkalemia and try to adjust blood potassium levels before reperfusion.
A systematic literature search was conducted in Web of Science, Scopus, Science Direct, and PubMed from January 1, 1990, to June 2023 for the published records on the recipients and donor-related characteristics known to contribute to the development of hyperkalemia after reperfusion during liver transplantation.
Higher baseline potassium, number and storage time of transfused RBC, administration of angiotensin receptor blockers, sodium bicarbonate, or bolus catecholamines, just before reperfusion, metabolic acidosis, low cardiac output, the use of venovenous bypass, lower intraoperative urine output, anesthesia time, and serum Albumin level, elevated effluent K levels, transplantation from an elderly donor, living-related donor, and donor with prolonged hospital stay known as risk factors of the occurrence of PRHK.
In this study, we reviewed all donor-and recipient-related factors contributing to postreperfusion hyperkalemia during liver transplantation. We suggest more meticulous research on pathophysiological mechanisms and predisposing factors of PRHK caused by ECD liver transplantation.
肝移植（LT）是治疗危及生命的肝脏疾病的一种众所周知的有效方法。这种复杂的手术与发病率和死亡率显著相关。高钾血症（血钾水平≥5 mEq/L的情况）是肝移植过程中随时可能发生的严重并发症，但在再灌注后5分钟内更频繁发生。血清钾水平的快速变化促使麻醉医生预测高钾血症的发生，并试图在再灌注前调整血钾水平。
于1990年1月1日至2023年6月在Web of Science、Scopus、Science Direct和PubMed上进行了系统的文献检索，以获取有关肝移植再灌注后已知会导致高钾血症发生的受者和供者相关特征的已发表记录。
较高的基线血钾、输注红细胞的数量和储存时间、再灌注前使用血管紧张素受体阻滞剂、碳酸氢钠或大剂量儿茶酚胺、代谢性酸中毒、低心输出量、使用静脉-静脉旁路、术中尿量减少、麻醉时间和血清白蛋白水平、流出液钾水平升高、来自老年供者、活体亲属供者以及住院时间延长的供者被认为是再灌注后高钾血症发生的危险因素。
在本研究中，我们回顾了肝移植再灌注后高钾血症的所有供者和受者相关因素。我们建议对边缘供肝肝移植引起的再灌注后高钾血症的病理生理机制和易感因素进行更细致的研究。
