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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Hyperkalemia: Major but still understudied complication among heart transplant recipients
Jagmeet Singh, Asim Kichloo, Navya Vipparla, Michael Aljadah, Michael Albosta, Shakeel Jamal, Sindhura Ananthaneni, Sandesh Parajuli
Jagmeet Singh, Department of Nephrology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Asim Kichloo, Navya Vipparla, Michael Albosta, Shakeel Jamal, Sindhura Ananthaneni, Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
Michael Aljadah, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Sandesh Parajuli, Department of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, United States
Author contributions: Singh J and Kichloo A were credited with substantial contribution to the design of the work, literature review of all the sections discussed, the revision of critically important intellectual content, final approval of the published version, and agreement of accountability for all aspects of the work; Vipparla N, Aljadah M and Albosta M were credited with substantial acquisition, analysis, and extraction of the literature reviewed for the manuscript, drafting the manuscript, final approval of the version to be published, and agreement of accountability for all aspects of the work; Jamal S was credited with significant contribution to the design of the manuscript and interpretation of the data, the revision of critically important intellectual content, final approval of the version to be published, and agreement of accountability for all aspects of the work; Ananthaneni S was credited with revision of the manuscript, mainly hyperkalemia management, final approval of the version to be published, and agreement of accountability for all aspects of the work; Parajuli S is credited with literature review, drafting the revision of the manuscript, final approval of the version to be published, and agreement of accountability for all aspects of the work.
Conflict-of-interest statement: The authors report no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Michael Albosta, MD, Doctor, Department of Internal Medicine, Central Michigan University College of Medicine, 1000 Houghton Ave, Saginaw, MI 48602, United States. albos1ms@cmich.edu
Received: February 7, 2021
Peer-review started: February 7, 2021
First decision: March 17, 2021
Revised: March 17, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: June 18, 2021
Hyperkalemia is a recognized and potentially life-threatening complication of heart transplantation. In the complex biosystem created by transplantation, recipients are susceptible to multiple mechanisms for hyperkalemia which are discussed in detail in this manuscript. Hyperkalemia in heart transplantation could occur pre-transplant, during the transplant period, or post-transplant. Pre-transplant causes of hyperkalemia include hypothermia, donor heart preservation solutions, conventional cardioplegia, normokalemic cardioplegia, continuous warm reperfusion technique, and ex-vivo heart perfusion. Intra-transplant causes of hyperkalemia include anesthetic medications used during the procedure, heparinization, blood transfusions, and a low output state. Finally, post-transplant causes of hyperkalemia include hemostasis and drug-induced hyperkalemia. Hyperkalemia has been studied in kidney and liver transplant recipients, but there is limited data on the incidence, causes, management, and prevention in heart transplant recipients. Hyperkalemia is associated with an increased risk of hospital mortality and readmission in these patients. This review describes the current literature pertaining to the causes, pathophysiology, and treatment of hyperkalemia in patients undergoing heart transplantation and focuses primarily on post-heart transplantation.
Core Tip: Hyperkalemia is a potentially life-threatening complication of heart transplantation. Recipients of heart transplant are susceptible to hyperkalemia via multiple mechanisms both during transplantation, as well as in the pre- and post-transplant periods. Hyperkalemia has been well studied in kidney and liver transplantation, however data is limited regarding the incidence, causes, management, and prevention in heart transplant recipients.
