Intraoperative Hypokalemia in Pediatric Liver Transplantation: Incidence and Risk Factors

Abstract

In this retrospective study of 268 children undergoing liver transplantation, we investigated the incidence of intraoperative potassium (K⁺) disturbances and the risk factors for hypokalemia in the preperfusion and postreperfusion periods. Overall, hypokalemia was the predominant disturbance, occurring in 72.0% of pediatric patients during liver transplantation. Hypokalemia was more common during the postreperfusion period than the prereperfusion period. Hyperkalemia, though a commonly cited complication, was infrequent during pediatric liver transplantation. Using multivariate logistic regression analysis, baseline serum K⁺ ≤3.5 mmol/L, base excess >5 mmol/L, and creatinine ≤0.5 mg/dL were found to be predictors for hypokalemia in the prereperfusion period; and body weight ≤15 kg, K⁺ ≤3.5 mmol/L, fresh-frozen plasma transfusion >90 mL/kg, and absence of ascites at surgery were independent predictors for hypokalemia in the postreperfusion period. These findings support the use of K⁺ replacement to maintain normokalemia and avoid the potential complications related to hypokalemia in pediatric liver transplantation, especially in children with the risk factors for hypokalemia.