The association between potassium level during the anhepatic stage of orthotopic liver transplantation and postoperative acute kidney injury: an exploratory study.

BACKGROUND: Acute kidney injury (AKI) refers to a clinical syndrome characterized by a sudden decrease in kidney function over a short period, with clinical manifestations ranging from a slight increase in serum creatinine to anuric renal failure.As a common complication following liver transplantation (LT), often accompanying significant electrolyte imbalances. The predictive value of serum potassium imbalances for the development of AKI in LT merits further investigation. Our study focuses on examining the correlation between the two variables then evaluates the efficacy of potassium levels as a predictive biomarker. METHODS: In this single-center, retrospective study, we examined 136 adult patients who underwent orthotopic LT at Qingdao University Affiliated Hospital from October 1, 2022 to July 31, 2023. Patients were stratified by their serum potassium levels during the anhepatic stage (Group A 3.0 ≤ K + ≤ 3.5; Group B 3.6 ≤ K + ≤ 4.0; Group C 4.1 ≤ K + ≤ 4.5). Their intraoperative potassium fluctuations and postoperative AKI were compared. Logistic regression analysis was conducted to determine risk factors for AKI. The receiver operating characteristic curve was utilized to assess the predictive value of intraoperative serum potassium for AKI. RESULTS: In neo-hepatic phase, potassium levels peaked early and then declined, with Group C showing higher rates of post-reperfusion hyperkalemia and AKI (p < 0.05). Regression analysis identified anhepatic potassium (OR:9.597,95%CI:3.169,29.064) as independent predictors of AKI following LT. The receiver operating characteristic curve revealed an optimal potassium cutoff of 4.05 mmol/L. CONCLUSION: This study indicates that serum potassium at anhepatic stage is an independent risk factor for AKI following LT, capable of predicting the onset of AKI. TRIAL REGISTRATION: This study is a retrospective study, and it has already been approved by the Ethics Committee.