Postreperfusion hyperkalemia in liver trans-plantation using donation after cardiac death grafts with pathological changes

• Published in: 国际肝胆胰疾病杂志（英文版） 2016, Vol.15 (5), p.487-492
• Main Author: Wen-Jin Zhang Wei-Liang Xia Hui-Yun Pan Shu-Sen Zheng
• Format: Article
• Language: English
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(16)60116-9

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 postreperfu-sion hyperkalemia in liver transplantation has increased sig-niifcantly. 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 pa-tients 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 clas-siifed into ifve categories. Univariate analysis was performed using Chi-square test to identify variables that were signiif-cantly different between two groups. Multivariate logistic regression was used to conifrm 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 re-perfusion and the difference in mean arterial pressure values before and within 5 minutes after reperfusion. RESULTS: Twenty-two of 131 liver recipients had hyperkale-mia episodes within 5 minutes after reperfusion. The rate of hyperkalemia was signiifcantly higher in recipients of macro-steatotic DCD graft liver (78.6%,P<0.001) than that in recipi-ents 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). Macroste-atosis 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 po-tassium 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.