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Original Research

Open Access Special Issue

Standard effluent potassium concentration as a predictive factor for postreperfusion significant arrhythmias in deceased liver transplantation

  • Liang Zhang1
  • Fu-Shan Xue1
  • Ming Tian1
  • Zhi-Jun Zhu2

1Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, 100050 Beijing, China

2Liver Transplantation Center, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, 100050 Beijing, China

DOI: 10.22514/sv.2021.121

Submitted: 01 May 2021 Accepted: 31 May 2021

Online publish date: 08 July 2021

*Corresponding Author(s): Ming Tian E-mail: tianmingbfh@gmail.com
*Corresponding Author(s): Zhi-Jun Zhu E-mail: zhu-zhijun@outlook.com

Abstract

Objectives: Postreperfusion significant arrhythmias (PRSA), which is known as part of the diagnostic criteria for postreperfusion syndrome, may serve as a precursor of postreperfusion cardiac arrest (PRCA). Considering the possible relationship between the use of liver grafts with high effluent potassium (eK+) concentrations and PRCA, we aimed to investigate the role of eK+ in PRSA development in deceased liver transplantation (LT).

Methods: Using the prospectively collected data from a prior observational study, a retrospective study of 91 adult LT recipients with eK+ measurements between November 2016 and December 2018 was conducted to determine the incidence, predictors, and outcomes of PRSA.

Results: PRSA occurred in 46 cases (50.5%), and PRCA occurred in 8 patients (8.8%). Multivariable analysis demonstrated elevated eK+ concentration before reperfusion (odds ratio [OR], 1.425; 95% confidence interval [CI] 1.134–1.790; P = 0.002), and higher serum potassium level at one minute following reperfusion (sK+1) (OR, 3.244; 95% CI 1.668–6.380; P = 0.001) as independent risk factors for PRSA. An eK+ ≥6.9 mmoL/L could predict PRSA with a sensitivity of 71.7% and a specificity of 80.0% (area under the receiver-operating characteristics curve [AUROC], 0.828). In comparison, an sK+1 ≥5.5 mmoL/L could predict PRSA with a sensitivity of 87.0% and a specificity of 64.4% (AUROC, 0.810). PRSA was associated with increased risks of PRCA, postreperfusion vasoplegia, and postoperative early allograft dysfunction.

Conclusions: This study has demonstrated that eK+ has the potential to predict PRSA in deceased LT. These findings need confirmation in further studies.


Keywords

Potassium; Effluent; Hyperkalemia; Arrhythmias; Cardiac arrest; Postreperfusion syndrome; Liver transplantation


Cite and Share

Liang Zhang,Fu-Shan Xue,Ming Tian,Zhi-Jun Zhu. Standard effluent potassium concentration as a predictive factor for postreperfusion significant arrhythmias in deceased liver transplantation. Signa Vitae. 2021.doi:10.22514/sv.2021.121.

References

[1] Croome KP, Lee DD, Croome S, Chadha R, Livingston D, Abader P, et al. The impact of postreperfusion syndrome during liver transplantation using livers with significant macrosteatosis. American Journal of Transplantation. 2019; 19: 2550–2559.

[2] Croome KP, Mathur AK, Mao S, Aqel B, Piatt J, Senada P, et al. Perioperative and long‐term outcomes of utilizing donation after circulatory death liver grafts with macrosteatosis: a multicenter analysis. American Journal of Transplantation. 2020; 20: 2449–2456.

[3] Chadha RM, Croome KP, Aniskevich S, Pai S, Nguyen J, Burns J, et al. Intraoperative Events in Liver Transplantation Using Donation after Circulatory Death Donors. Liver Transplantation. 2019; 25: 1833–1840.

[4] Smith NK, Zerillo J, Kim SJ, Efune GE, Wang C, Pai S, et al. Intra-operative Cardiac Arrest during Adult Liver Transplantation: Incidence and Risk Factor Analysis from 7 Academic Centers in the United States. Anesthesia & Analgesia. 2021; 132: 130–139.

[5] Aufhauser DD, Rose T, Levine M, Barnett R, Ochroch EA, Aukburg S, et al. Cardiac arrest associated with reperfusion of the liver during transplantation: incidence and proposal for a management algorithm. Clinical Transplantation. 2013; 27: 185–192.

[6] Matsusaki T, Hilmi IA, Planinsic RM, Humar A, Sakai T. Cardiac arrest during adult liver transplantation: a single institution’s experience with 1238 deceased donor transplants. Liver Transplantation. 2013; 19: 1262–1271.

[7] Lee SH, Gwak MS, Choi SJ, Shin YH, Ko JS, Kim GS, et al. Intra-operative cardiac arrests during liver transplantation—a retrospective review of the first 15 yr in Asian population. Clinical Transplantation. 2013; 27: E126–E136.

[8] Shi X, Xu Z, Xu H, Jiang J, Liu G. Cardiac arrest after graft reperfusion during liver transplantation. Hepatobiliary & Pancreatic Diseases International. 2006; 5: 185–189.

[9] Andjelić N, Erdeljan S, Popović R, Božić T. Anaphylaxis on Graft Reperfusion during Orthotopic Liver Transplantation: a Case Study. Srpski Arhiv za Celokupno Lekarstvo. 2015; 143: 467–470.

[10] Kim S, DeMaria S, Cohen E, Silvay G, Zerillo J. Prolonged Intraoperative Cardiac Resuscitation Complicated by Intracardiac Thrombus in a Patient Undergoing Orthotopic Liver Transplantation. Seminars in Cardiothoracic and Vascular Anesthesia. 2016; 20: 246–251.

[11] Wang C, Cheng K, Chen C, Wu S, Shih T, Yang S, et al. The effectiveness of prophylactic attachment of adhesive defibrillation pads in adult living donor liver transplantation. Annals of Transplantation. 2015; 20: 97–102.

[12] Zhang L, Tian M, Sun L, Zhu Z. Association between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation. Medical Science Monitor. 2017; 23: 5158–5167.

[13] Zhang L, Tian M, Wei L, Zhu Z. Expanded Criteria Donor-Related Hyper-kalemia and Postreperfusion Cardiac Arrest during Liver Transplantation: a Case Report and Literature Review. Annals of Transplantation. 2018; 23: 450–456.

[14] Zhang L, Tian M, Xue F, Zhu Z. Diagnosis, Incidence, Predictors and Management of Postreperfusion Syndrome in Pediatric Deceased Donor Liver Transplantation: a Single-Center Study. Annals of Transplantation. 2018; 23: 334–344.

[15] Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements. 2012; 2: 1–138.

[16] Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transplantation. 2010; 16: 943–949.

[17] Dawwas MF, Lewsey JD, Watson CJ, Gimson AE. The Impact of Serum Potassium Concentration on Mortality after Liver Transplantation: a Cohort Multicenter Study. Transplantation. 2009; 88: 402–410.

[18] Aggarwal S, Kang Y, Freeman JA, Fortunato FL, Pinsky MR. Postreper-fusion syndrome: hypotension after reperfusion of the transplanted liver. Journal of Critical Care. 1993; 8: 154–160.

[19] Pan X, Apinyachon W, Xia W, Hong JC, Busuttil RW, Steadman RH, et al. Perioperative complications in liver transplantation using donation after cardiac death grafts: a propensity-matched study. Liver Transplantation. 2014; 20: 823–830.

[20] Zhang W, Xia W, Pan H, Zheng S. Postreperfusion hyperkalemia in liver transplantation using donation after cardiac death grafts with pathological changes. Hepatobiliary & Pancreatic Diseases International. 2016; 15: 487–492.

[21] Patrono D, Romagnoli R. Postreperfusion syndrome, hyperkalemia and machine perfusion in liver transplantation. Translational Gastroenterol-ogy and Hepatology. 2019; 4: 68.

[22] Koshy AN, Ko J, Farouque O, Cooray SD, Han H, Cailes B, et al. Effect of QT interval prolongation on cardiac arrest following liver transplantation and derivation of a risk index. American Journal of Transplantation. 2021; 21: 593–603.

[23] Cailes B, Koshy AN, Gow P, Weinberg L, Srivastava P, Testro A, et al. Inducible Left Ventricular Outflow Tract Obstruction in Patients Undergoing Liver Transplantation: Prevalence, Predictors, and Association with Cardiovascular Events. Transplantation. 2021; 105: 354–362.

[24] Bezinover D, Kadry Z, McCullough P, McQuillan PM, Uemura T, Welker K, et al. Release of cytokines and hemodynamic instability during the reperfusion of a liver graft. Liver Transplantation. 2011; 17: 324–330.

[25] Fukazawa K, Nishida S, Hibi T, Pretto EA. Crystalloid flush with backward unclamping may decrease post-reperfusion cardiac arrest and improve short-term graft function when compared to portal blood flush with forward unclamping during liver transplantation. Clinical Transplantation. 2013; 27: 492–502.

[26] Fiegel M, Cheng S, Zimmerman M, Seres T, Weitzel NS. Postreperfusion Syndrome during Liver Transplantation. Seminars in Cardiothoracic and Vascular Anesthesia. 2012; 16: 106–113.


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