Related Experiment Video
Updated: Mar 13, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Postreperfusion hyperkalemia in liver transplantation using donation after cardiac death grafts with pathological
Wen-Jin Zhang1, Wei-Liang Xia, Hui-Yun Pan
1Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. shusenzheng@zju.edu.cn.
Insights
Macrosteatosis in donor livers from donation after cardiac death (DCD) significantly increases the risk of postreperfusion hyperkalemia and postreperfusion syndrome in liver transplant recipients.
Area of Science:
- Transplantation Medicine
- Organ Donation
- Nephrology
Background:
- Increasing use of donation after cardiac death (DCD) livers, particularly those with steatosis, has led to a rise in postreperfusion hyperkalemia.
- Postreperfusion hyperkalemia is a significant complication in liver transplantation.
- Identifying risk factors for postreperfusion hyperkalemia is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the factors associated with developing postreperfusion hyperkalemia in liver transplantation using DCD grafts.
- To investigate the impact of graft liver steatosis on hyperkalemia incidence.
- To analyze the relationship between graft characteristics and postreperfusion syndrome.
Main Methods:
- Retrospective study of 131 adult liver transplant recipients from DCD donors.
- Classification of DCD graft livers based on preoperative biopsy results (macrosteatosis).
- Statistical analysis including univariate and multivariate logistic regression to identify risk factors.
Main Results:
- Twenty-two of 131 recipients (16.8%) experienced postreperfusion hyperkalemia.
- Hyperkalemia occurred significantly more often in recipients of macrosteatotic DCD livers (78.6%) compared to non-macrosteatotic livers.
- Macrosteatosis in DCD graft livers was an independent risk factor for hyperkalemia (Odds Ratio: 51.3) and postreperfusion syndrome (71.4%).
Conclusions:
- Macrosteatosis in DCD graft livers is a significant independent risk factor for postreperfusion hyperkalemia.
- Macrosteatosis is also associated with an increased incidence of postreperfusion syndrome.
- Management strategies should consider graft liver steatosis in DCD liver transplantation.
Background:
With the increasing use of donation after cardiac death (DCD), especially of the graft liver with steatosis or other pathological changes, the frequency of postreperfusion hyperkalemia in liver transplantation has increased significantly. The present study aimed to determine the factors associated with developing postreperfusion hyperkalemia in liver transplantation from DCD.
Methods:
One hundred thirty-one consecutive adult patients who underwent orthotopic liver transplantation from DCD were retrospectively studied. Based on serum potassium within 5 minutes after reperfusion, recipients were divided into two groups: hyperkalemia and normokalemia. According to preoperative biopsy results, the DCD graft livers were classified into five categories. Univariate analysis was performed using Chi-square test to identify variables that were significantly different between two groups. Multivariate logistic regression was used to confirm the risk factors of developing hyperkalemia and postreperfusion syndrome. Correlation analysis was used to identify the relationship between the serum concentration of potassium within 5 minutes after reperfusion and the difference in mean arterial pressure values before and within 5 minutes after reperfusion.
Results:
Twenty-two of 131 liver recipients had hyperkalemia episodes within 5 minutes after reperfusion. The rate of hyperkalemia was significantly higher in recipients of macrosteatotic DCD graft liver (78.6%, P<0.001) than that in recipients of non-macrosteatotic DCD graft liver. The odds ratio of developing postreperfusion hyperkalemia in recipients of macrosteatotic DCD graft liver was 51.3 (P<0.001). Macrosteatosis in the DCD graft liver was an independent risk factor of developing hyperkalemia within 5 minutes after reperfusion. The highest rate of postreperfusion syndrome also occurred in the recipients with macrosteatotic DCD graft liver (71.4%, P<0.001). A strong relationship existed between the serum potassium within 5 minutes after reperfusion and the difference in mean arterial pressure values before and within 5 minutes after reperfusion in macrosteatotic DCD graft liver recipients.
Conclusion:
Macrosteatosis in the DCD graft liver was an independent risk factor of developing hyperkalemia and postreperfusion syndrome in the recipients.
Related Concept Videos
01:26Kidney Transplant II: Surgical Procedure
01:28Kidney Transplant I: Introduction