title: Differentiated therapy with prostaglandin E1 (alprostadil) after orthotopic liver transplantation: the usefulness of procalcitonin (PCT) and hepatic artery resistive index (RI) for the evaluation of early graft function and clinical course.
abstract: Increasing demand for donor organs has led to new pharmacological concepts for reducing ischemia-reperfusion injury (I/R) of the graft after liver transplantation to prevent primary non-functioning of the organ. Prostaglandins have proved to be cytoprotective in several experimental models of ischemia and transplantation. The prophylactic administration after orthotopic liver transplantation is still a subject of controversial discussion. The aim of our study was the evaluation of the post-transplant hepatic artery resistive index (RI) measured by color Doppler imaging, in combination with postoperative elevation of transaminases, as parameters indicating the need for a differentiated systemic therapy with prostaglandin E1 (PGE1) (alprostadil). In addition, the value of serum procalcitonin (PCT) as a postoperative parameter for the extent of I/R is investigated. In the case of post-transplant elevated hepatic artery RI (RI > 0.75), the administration of PGE1 led to a significant reduction of transaminases (p < 0.05) and a decline of the RI. In addition, postoperative PCT levels could be reduced significantly by PGE1 application. These results suggest that determination of RI is feasible for indicating a need for therapy with PGE1. Its targeted application reduces hepatocellular damage due to I/R after liver transplantation.
authors.affiliation: Department of General and Visceral Surgery, Friedrich-Schiller-University, Jena, Germany. Kornberg@bach.med.uni-jena.de
authors.forename: A
authors.initials: A
authors.lastname: Kornberg
authors.forename: T
authors.initials: T
authors.lastname: Grube
authors.forename: T
authors.initials: T
authors.lastname: Wagner
authors.forename: R
authors.initials: R
authors.lastname: Voigt
authors.forename: M
authors.initials: M
authors.lastname: Homman
authors.forename: U
authors.initials: U
authors.lastname: Schotte
authors.forename: K
authors.initials: K
authors.lastname: Schmidt
authors.forename: J
authors.initials: J
authors.lastname: Scheele
mesh_terms: D000527:Alprostadil / Q000627:therapeutic use*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006085:Graft Survival; D006499:Hepatic Artery / Q000502:physiology*; D006801:Humans; D016031:Liver Transplantation; D011498:Protein Precursors / Q000097:blood*; D000637:Transaminases / Q000097:blood; D014655:Vascular Resistance
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D000637:Transaminases; D000527:Alprostadil; D015740:Calcitonin Gene-Related Peptide