Intraoperative hypokalemia in pediatric liver transplantation: Incidence and risk factors

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.