Analysis Of Serum Potassium Changes And Risk Factors Within A Short Time After Potal Vein Opening In Liver Transplantation

Background: Liver transplantation is the best choice for the treatment of end-stage liver disease.Perioperative hemodynamic fluctuation is large,especially in a short time after portal vein opening,blood potassium concentration will change dramatically,leading to hyperkalemia,malignant arrhythmia,cardiac arrest,postreperfusion syndrome and other adverse events.Nevertheless,previous studies mostly focus on the analysis of blood potassium during the whole perioperative period.The observation interval is long,and there is still a lack of accurate description of the trends of blood potassium in a short time after portal vein opening.Therefore,this study uses a blood circulation cycle of about 20 seconds as a reference to shorten the observation period of changes in blood potassium.Objective: To observe the changes of blood potassium within ten minutes after portal vein opening in liver transplantation and to explore the risk factors of hyperkalemia after portal vein opening,so as to provide the basis for clinical prediction of abnormal blood potassium in the reperfusion stage.Method: This study was a retrospective analysis of prospectively collected data,which resulted from a prospective observational study.Data of 110 patients under liver transplantation during May-December of 2019 in our hospital were collected.The serum potassium concentration at the time of anesthesia induction(T0),prereperfusion(T1),immediate reperfusion(T2),20 s after reperfusion(T3),40 s after reperfusion(T4),60 s after reperfusion(T5),120 s after reperfusion(T6),300 s after reperfusion(T7)and 600 s after reperfusion(T8)were recorded to compare the changes of serum potassium before and after potal vein opening.Patients were divided into hyperkalemia group(serum potassium was ≥5.5 mmol/L after portal vein opening)and non-hyperkalemia group(serum potassium was <5.5 mmol/L).The factors with significant differences in univariate analysis were incorporated into Logistic multiple analysis.Results: Forty three patients developed hyperkalemia within ten minutes of portal vein opening in the reperfusion stage,and 67 patients did not.During this period,the potassium concentration of the two groups increased first and then decreased.From T1 to T4,the potassium concentration increased significantly,and from T4 to T8,the blood potassium concentration decreased significantly(P<0.05).Compared with T0,potassium concentration was higher in T1-T6 and lower in T7-T8(P<0.05).There was no significant difference in potassium concentration between hyperkalemia group and non-hyperkalemia group at T0,T7 and T8(P>0.05).But at T1-T6,potassium concentration in hyperkalemia group was significantly higher than that in non-hyperkalemia group(P<0.05).At T7 and T8,a total of 71 patients in the two groups developed hypokalemia.According to the univariate analysis of the factors related to hyperkalemia after portal vein opening,a total of four factors which including cold ischemia time,input of red blood cells before opening,prereperfusion serum potassium concentration,liver allograft steatosis were found to be significantly different between two groups(P<0.05).Multivariate logistic regression analysis showed that cold ischemia time(OR=1.076;95%CI 1.067-8.825;P<0.001),prereperfusion serum potassium concentration(OR=1.364;95%CI 1.018-1.259;P=0.018),and donor liver with steatosis(OR=1.793;95%CI 1.094-3.471;P=0.012)were independent risk factors for hyperkalemia after portal vein opening.Compared with the non-hyperkalemia group,the hyperkalemia group had a higher incidence of postreperfusion syndrome(P=0.022)and cardiac arrest(P=0.023).There was no statistically significant difference between the two groups of patients in terms of mechanical ventilation time,ICU hospitalization days,total hospitalization days,and mortality during hospitalization.Conclusion: In liver transplantation,the blood potassium disorder within 10 minutes after portal vein opening is manifested as an initial transient increase and subsequent decrease in blood potassium level.Compared with hypokalemia in the reperfusion stage,transient hyperkalemia is closely related to the occurrence of postreperfusion syndrome and cardiac arrest,and more vigilance is needed.Prereperfusion serum potassium concentration,cold ischemia time and liver allograft steatosis were independent risk factors for hyperkalemia after portal vein opening.Therefore,more efforts should be made to maintain a low serum potassium level within the normal range during the anhepatic period,shorten the cold ischemia time,optimize the application of donor liver with steatosis to reduce the occurrence of hyperkalemia.