gms | German Medical Science

Introduction: Orthotopic liver transplantation (OLT) is a treatment for end stage liver disease. Shortage of available organs leads to the acceptance of marginal grafts and increases the risk of perioperative complications like acute rejection, infection and graft dysfunction. PCT was shown to be a reliable marker for complicated course after trauma and in the course of SIRS and sepsis. The aim of the study was to evaluate Procalcitonin (PCT) as an early prognostic marker for occurrence of complication in the postoperative course after OLT.

Materials and methods: We included 32 patients who underwent 33 OLTs and analysed the levels of PCT and clinical and paraclinical data. The highest PCT was defined as peak- PCT. Patients were stratified in a non-complication and a complication group. Renal replacement therapy, respiratory insufficiency, postoperative bleeding, refractory ascites and pleural effusion, rejection, sepsis and fatal outcome were defined as complication. A secondary stratification was performed using a peak- PCT of 5ng/ml in each group. Then, we analysed the risk of occurrence of a complication according to a peak- PCT of 5ng/ml. Further we analysed the course of PCT after OLT in each group.

Results: The peak- PCT occurred between the first and third postoperative day in 30 patients, followed by halvening every second day. Nevertheless, 3 of them died because of sepsis. A constantly rising PCT or a secondary rise was seen in 2 patients and associated with fatal outcome.18 patients were stratified in the non- complication group, 8 with peak- PCT lower than 5ng/ml and 10 higher. 14 patients with 15 transplantations were stratified in the complication group, only 1 patient developed a peak- PCT below 5ng/ml. The odds ratio of running a complication was 11.2 (10.81 – 11.59; p<0,025) when the peak- PCT was higher than 5ng/ml. However, the course of mean PCT levels was significant between the complication and non- complication group not before the 7th postoperative day.

Conclusion: PCT is a reliable marker for SIRS and sepsis and rises with the severity of the disease and due to operative trauma. A decline was seen in 31 cases, in 2 cases we observed a constantly rising level, and both patients had a fatal outcome. This observation was described before for non transplant patients. In transplant patients, an elevation of PCT was only seen in bacterial infections, but not in rejection or wound infection. We have seen a rise of PCT in respiratory failure and sepsis, but not in renal replacement therapy, ascites, pleural effusion, rejection or bleeding. An initial high PCT is described not to indicate a poor prognosis, and patients of the non-complication group also had levels exceeding 15ng/ml. The patients of the complication group had a higher mean PCT, which turned significant not before the 7th day, most probably because of the high variation of levels. Still, a peak- PCT above 5ng/ml has an odds ratio of 11.2 for patients to experience a complication.