Pathophysiological mechanisms of postrevascularization hyperkalemia in orthotopic liver transplantation

Citation
M. Nakasuji et Mj. Bookallil, Pathophysiological mechanisms of postrevascularization hyperkalemia in orthotopic liver transplantation, ANESTH ANAL, 91(6), 2000, pp. 1351-1355
Citations number
17
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ANESTHESIA AND ANALGESIA
ISSN journal
0003-2999 → ACNP
Volume
91
Issue
6
Year of publication
2000
Pages
1351 - 1355
Database
ISI
SICI code
0003-2999(200012)91:6<1351:PMOPHI>2.0.ZU;2-4
Abstract
The underlying mechanisms of hyperkalemia occurring immediately after revas cularization in orthotopic liver transplantation (OLT) are unknown. We inve stigated the possible pathophysiological mechanisms of hyperkalemia in rela tion to the donor and recipient. The study included 64 consecutive patients undergoing OLT. Recipients were divided into two groups: Group 1 consisted of 47 patients with serum K+ concentration <5.5 mmol/L at 1-min postrevasc ularization, and Group 2 consisted of 17 patients with serum K+ exceeding 5 .5 mmol/L. Increased serum K+ concentration, more progressive metabolic aci dosis, and decreased mean arterial blood pressure and cardiac index during the anhepatic phase were recognized in Group 2. Multiple regression analysi s showed that cardiac index, serum lactate, and serum K+ concentration duri ng the anhepatic phase were independent and significant factors that could predict serum K+ concentration 1-min postrevascularization. Hyperkalemia at 1-min postrevascularization did not correlate with the extent of preservat ion injury of the graft liver (represented by the peak value of aspartate a minotransferase measured within the first 72 h after OLT) or the duration o f cold ischemia. We conclude that hyperkalemia occurring immediately after revascularization in OLT is mainly caused by metabolic acidosis as a result of insufficient cardiac output during the anhepatic phase.