Changes in Blood Potassium after Reperfusion during Living-Donor Liver Transplantation: An Exploratory Study

The incidence of hyperkalemia (>5.5 mEq/L) or high blood potassium (5–5.5 mEq/L) during living-donor liver transplantation (LDLT) is reported to be more than 10%. It occurs more frequently in the early post-reperfusion period and is a major cause of post-reperfusion arrhythmia and cardiac arrest. Unlike deceased-donor liver transplantation, the pattern of blood potassium changes immediately after reperfusion has not been described in LDLT. From January 2021 to March 2021, fifteen consecutive patients were enrolled. Baseline blood potassium was measured from blood samples obtained 10-min (T(-10)) and immediately before (T(0)) reperfusion. During the first 5 min after reperfusion, blood potassium measurements were conducted every one minute (T(1)–T(5)). The blood potassium levels at T(-10) and T(0) were 3.8 ± 0.4 and 3.9 ± 0.4 mEq/L, respectively. After reperfusion, mean increases (95% CI) in blood potassium from T(-10) and T(0) were 0.5 (0.4–0.6) and 0.4 (0.3–0.5) mEq/L, respectively. Blood potassium peaked at T(1), returned to baseline at T(3), and fell below the baseline at T(5). Peak blood potassium after reperfusion showed strong correlations with blood potassium measured at T(-10) (p < 0.001) and T(0) (p < 0.0001). These findings can support the establishment of future research plans and perioperative management of blood potassium in LDLT.