A systematic review on predictors of postreperfusion hyperkalemia during liver transplantation

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.