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

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


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. Pretransplant 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.

Original languageEnglish
Pages (from-to)203-211
Number of pages9
JournalWorld Journal of Transplantation
Issue number6
StatePublished - Jun 2021


  • Cardiovascular
  • Heart transplant
  • Hyperkalemia
  • Management
  • Medication
  • Transplantation


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