Significance of Perioperative Procalcitonin Measurement in Patients Undergoing Liver Transplantation.

Abstract

Severe sepsis is a life-threatening complication after liver transplantation (LT) that can be difficult to diagnose and appropriately treat after LT due to patients being administered with immunosuppressants. The present study examines perioperative changes in serum procalcitonin (PCT), a specific marker of systemic bacterial infection, and determines the value of PCT as a diagnostic tool for bacteremia or rejection. Perioperative serum PCT levels were prospectively assessed in 104 adult patients undergoing LT (living donor LT, n = 90; deceased donor LT, n = 14) between May 2010 and August 2012. Serum PCT levels remarkably increased soon after LT and gradually decreased thereafter, but were not increased in patients diagnosed with cytomegalovirus infection or acute cellular rejection. Serum PCT levels in patients who underwent deceased donor LT were significantly higher than those who underwent living donor LT until postoperative day (POD) 7. However, no differences were found between these two groups after POD 14. Serum PCT levels were significantly higher in patients with bacteremia than those without bacteremia after POD 5. PCT levels in patients with bacteremia who died within three months of LT and in patients who survived increased again and remained low, respectively after POD 7. A positive predictive value of 83.3% for bacteremia and a negative predictive value of 97.4% were obtained at PCT cut-offs of 2.0 and 0.5 ng/mL, respectively.In conclusions, perioperative PCT measurement would be useful to predict the prognosis of patients and differentiate bacteremia from rejection after LT.