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Exchange Autotransfusion for Rapid Correction of Hyperkalemia During Liver Transplantation

A Case Report

Yoon, Uzung, MD, MPH; Gerney, Garrett, MD; Hsu, George, MD; Elia, Elia, MD; Kang, Yoogoo, MD

doi: 10.1213/XAA.0000000000000831
Case Reports

A 46-year-old woman with alcoholic cirrhosis and hepatorenal syndrome requiring hemodialysis presented with hyperkalemia (5.5 mEq/L) immediately before liver transplantation. For correction of hyperkalemia, an exchange transfusion began by removing her blood into an autotransfusion system to wash out noncellular components while maintaining normovolemia. Additionally, she received washed homologous red blood cells, insulin, and glucose to minimize or reduce the degree of hyperkalemia. Serum potassium level decreased to 4.0 mEq/L within 3 hours and was 5.0 mEq/L 30 seconds after reperfusion of the grafted liver. Postreperfusion syndrome was not observed. In summary, exchange transfusion was used successfully for rapid correction of hyperkalemia, showing the value of its application in liver transplantation.

From the Department of Anesthesiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.

Accepted for publication May 22, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Uzung Yoon, MD, MPH, Department of Anesthesiology, Thomas Jefferson University Hospital, Suite 8290 Gibbon, 111 S 11th St, Philadelphia, PA 19107. Address e-mail to

© 2019 International Anesthesia Research Society
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