Role of biomarkers in early infectious complications after lung transplantation.

Ascension Garcia Campos,Rosario Vicente,Eduardo Miñambres,Borja Suberviola,Luzdivina Rellan,Reyes Iranzo,Juan Carlos Robles,Jordi Riera,Miguel Santibanez

doi:10.1371/journal.pone.0180202

Abstract

BackgroundInfections and primary graft dysfunction are devastating complications in the immediate postoperative period following lung transplantation. Nowadays, reliable diagnostic tools are not available. Biomarkers could improve early infection diagnosis.MethodsMulticentre prospective observational study that included all centres authorized to perform lung transplantation in Spain. Lung infection and/or primary graft dysfunction presentation during study period (first postoperative week) was determined. Biomarkers were measured on ICU admission and daily till ICU discharge or for the following 6 consecutive postoperative days.ResultsWe included 233 patients. Median PCT levels were significantly lower in patients with no infection than in patients with Infection on all follow up days. PCT levels were similar for PGD grades 1 and 2 and increased significantly in grade 3. CRP levels were similar in all groups, and no significant differences were observed at any study time point. In the absence of PGD grade 3, PCT levels above median (0.50 ng/ml on admission or 1.17 ng/ml on day 1) were significantly associated with more than two- and three-fold increase in the risk of infection (adjusted Odds Ratio 2.37, 95% confidence interval 1.06 to 5.30 and 3.44, 95% confidence interval 1.52 to 7.78, respectively).ConclusionsIn the absence of severe primary graft dysfunction, procalcitonin can be useful in detecting infections during the first postoperative week. PGD grade 3 significantly increases PCT levels and interferes with the capacity of PCT as a marker of infection. PCT was superior to CRP in the diagnosis of infection during the study period.

Highlights

Infection and primary graft dysfunction (PGD) are the most common and devastating complications in the immediate postoperative period following lung transplantation (LT) [1]
PCT levels were similar for PGD grades 1 and 2 and increased significantly in grade 3
In the absence of PGD grade 3, PCT levels above median (0.50 ng/ml on admission or 1.17 ng/ml on day 1) were significantly associated with more than two- and three-fold increase in the risk of infection

Summary

Introduction

Infection and primary graft dysfunction (PGD) are the most common and devastating complications in the immediate postoperative period following lung transplantation (LT) [1]. Direct contact of the allograft with the environment, impaired clearance mechanisms caused by allograft denervation and profound immunosuppression, especially in the first postoperative days, explain this high vulnerability of LT recipients to infection. Diagnosis of infectious complications after LT is imperative. This allows prompt initiation of antimicrobial therapy and adjustment of immunosuppressant therapy, and can prevent infection-related morbidity and mortality [3,4]. Lung infection and PGD share respiratory failure and lung infiltrates on chest X-ray as the most common symptoms making differential diagnosis complicated [5]. Infections and primary graft dysfunction are devastating complications in the immediate postoperative period following lung transplantation.

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