Abstract
Opportunistic bacterial infections are dreaded risks in patients following liver transplantation (LTX), even though patients receive an antibiotic prophylaxis. The timely recognition of such an infection may be delayed, as culture-based diagnostic methods are linked with a relevant gap in performance. We measured plasma concentrations of Delta-like canonical Notch ligand 1 (DLL1) in 93 adult patients at seven consecutive time points after liver transplantation and correlated the results to the occurrence of culture-proven bacterial infection or a complicated clinical course (composite endpoint of two or more complications: graft rejection or failure, acute kidney failure, acute lung injury, or 90-day mortality). Patients exhibited elevated plasma concentrations after liver transplantation over the whole 28 d observation time. Patients with bacterial infection showed increased DLL1 levels compared to patients without infection. Persistent elevated levels of DLL1 on day 7 and afterward following LTX were able to indicate patients at risk for a complicated course. Plasma levels of DLL1 following LTX may be useful to support an earlier detection of bacterial infections in combination with C-reactive protein (CRP) and procalcitonin (PCT), or they may lead to risk stratification of patients as a single marker for post-operative complications. (Clinical Trial Notation. German Clinical Trials Register: DRKS00005480).
Highlights
Since the first liver transplantation (LTX) in 1963 [1], the method has been become a routine therapeutic option in patients with end-stage liver diseases (ESLD)
Besides C-reactive protein (CRP), which has a low specificity after LTX due to an existing sterile inflammation, interleukin (IL)-6 might be a valuable marker for infectious complications [8], but it is often claimed to be unspecific
Represented the target group, whereas the remaining patients were defined as controls. Within this secondary analysis of a prospective clinical investigation in liver transplanted patients, Delta-like canonical Notch ligand 1 (DLL1) was shown to be a useful option for the detection of bacterial infections in patients following LTX, especially in combination with CRP and PCT
Summary
Since the first liver transplantation (LTX) in 1963 [1], the method has been become a routine therapeutic option in patients with end-stage liver diseases (ESLD). The quality of life of LTX patients has increased through the use of improved immunosuppressive treatment regimens as well as optimized standard care procedures [2,3]. These improvements are linked with an elevated risk for bacterial infections in the first year after LTX [4], which may lead to an increased. Often used as the gold standard in septic patients, PCT shows different kinetics in patients following LTX, with highly elevated levels directly after transplantation without having relevant infections [8,9]. The usefulness of these biomarkers in clinical routine, especially for complex transplant patients at inherently high risk for infection, is strongly limited
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