Hyperkalemia in liver transplantation.

William Chang, Ming-Ray Xu, Alexander George, Meredith Kingeter, Christopher Patrick Henson, Kelly Mishra, Martin Montenovo, Michael Rizzari, Kara Siegrist

Journal: Journal of clinical anesthesia 2025;103():111822

PMID: 40139028

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Abstract

Hyperkalemia commonly occurs in patients undergoing liver transplantation. The intraoperative course of liver transplant often involves hemodynamic and metabolic derangements leading up to liver reperfusion. Potassium levels can rise to dangerous levels immediately after reperfusion. The consequences of intraoperative hyperkalemia include risk of malignant arrhythmias and cardiac arrest. This review explores the numerous causes of hyperkalemia, including contributing surgical and anesthetic factors. The authors also discuss various treatment options and surgical techniques to manage perioperative hyperkalemia. It is important for anesthesiologists to understand the implications and management of hyperkalemia to optimize patients and reduce the risk of an intraoperative cardiac arrest.

Address: Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21(st) Avenue South, Nashville, TN 37212, United States of America. Electronic address: [email protected].; Vanderbilt University School of Medicine, 1161 21(st) Avenue South, Nashville, TN 37232, United States of America. Electronic address: [email protected].; Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21(st) Avenue South, Nashville, TN 37212, United States of America. Electronic address: [email protected].; Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21(st) Avenue South, Nashville, TN 37212, United States of America. Electronic address: [email protected].; Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21(st) Avenue South, Nashville, TN 37212, United States of America. Electronic address: [email protected].; Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21(st) Avenue South, Nashville, TN 37212, United States of America. Electronic address: [email protected].; Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN 37232, United States of America. Electronic address: [email protected].; Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN 37232, United States of America. Electronic address: [email protected].; Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21(st) Avenue South, Nashville, TN 37212, United States of America. Electronic address: [email protected].

DOI: 10.1016/j.jclinane.2025.111822

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MeSH Terms: Humans, Liver Transplantation, Hyperkalemia, Intraoperative Complications, Heart Arrest, Potassium, Anesthesia, Risk Factors