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Out of sight, out of mind, but at high risk: incidence, timing and risk factors for hyperkalemia after liver transplant discharge

Year: 2026

Type: article

Abstract: Background: Hyperkalemia occurs in liver transplant (LT) recipients due to calcineurin inhibitor initiation and post-operative renal dysfunction and is associated with significant patient morbidity and resource expenditures. Little is known about the prevalence and timing of hyperkalemia after LT discharge. Methods: Adults undergoing LT between 1/2022-12/2024 at a single transplant center were included, excluding simultaneous heart-liver transplant recipients and patients who died before discharge. The primary exposure was time to hyperkalemia (serum potassium > 5.0 mmol/L) within three months of LT discharge. Univariable and multivariable Cox proportional hazards regression was used to identify predictors of hyperkalemia. Results: Of 544 patients, 268 (49%) developed hyperkalemia within three months following LT discharge. Compared to patients without hyperkalemia, those who developed hyperkalemia were more likely to have diabetes mellitus (30% vs 20%, p=0.01) and higher laboratory MELD scores (29 vs 24, p=0.02). The median time to the first hyperkalemia episode was 11 days (IQR 5-28) after LT discharge, with the highest incidence occurring during the first week after discharge. 110 patients (20%) had hyperkalemia documented during readmission. On multivariable Cox regression, CKD stages 3a (aHR 1.63, 95% CI 1.11-2.40), 3b (aHR 2.38, 95% CI 1.51-3.74), and 5 (aHR 2.01, 95% CI 1.32-3.06); one week pre-transplant potassium (aHR 1.52, 95% CI 1.24-1.84); and discharge potassium (aHR 1.63, 95% CI 1.24-2.16) were independently associated with hyperkalemia. Conclusion: Hyperkalemia is common within the first three months following LT discharge. These findings support the development of risk-stratified surveillance and management guidelines to reduce hyperkalemia-related morbidity and healthcare utilization. Given the cost and access barriers associated with outpatient hyperkalemia treatment, targeted interventions are needed to safeguard patients after discharge.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2026.1924687