Procalcitonin in fever of unknown origin after liver transplantation: a variable to differentiate acute rejection from infection.
OBJECTIVE
Does procalcitonin (PCT) differentiate between infection and rejection after liver transplantation in patients with fever of unknown origin?


METHODS
Open prospective trial.


METHODS
Transplant intensive care unit at a university hospital.


METHODS
Forty patients after liver transplantation.


METHODS
Liver biopsy for the diagnosis of rejection and transcutaneous aspiration cytology for monitoring of lymphocyte activation.


METHODS
Procalcitonin from EDTA plasma, Acute Physiology and Chronic Health Evaluation II, and sepsis score.


RESULTS
Eleven patients experienced an infectious complication resulting in an increase in PCT concentrations (2.2-41.7 ng/mL). Eleven patients had a rejection episode; none of these patients showed a rise in PCT concentrations. The statistical difference between PCT concentrations in rejection and infection was significant (p<.05) on the day of diagnosis.


CONCLUSIONS
PCT allows for differentiation between rejection and infection in patients with fever of unknown origin. Elevation of PCT plasma concentrations develops early postoperatively from operation trauma, and in the case of fever of unknown origin, with no rise in PCT, a rejection may be suspected.
Kuse
E R
ER
Department of Abdominal and Transplantation Surgery, Medizinische Hochschule Hannover, Germany. Kuse.Ernst@MH-Hannover.DE
Langefeld
I
I
Jaeger
K
K
Külpmann
W R
WR
D018806:APACHE; D000704:Analysis of Variance; D001706:Biopsy; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D016002:Discriminant Analysis; D005335:Fever of Unknown Origin / Q000209:etiology*; D006084:Graft Rejection / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007239:Infections / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D016031:Liver Transplantation / Q000009:adverse effects*; D008213:Lymphocyte Activation; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide