Procalcitonin for differential diagnosis of graft rejection and infection in patients with heart and/or lung grafts.
OBJECTIVE
Investigation of the reliability of Procalcitonin (PCT) for differential diagnosis of acute rejections and non-viral infections in heart and lung transplanted patients.


METHODS
Retrospective study.


METHODS
Transplant intensive care unit (ICU) at a university hospital.


METHODS
57 heart, 18 lung and 3 heart-lung transplant patients.


METHODS
PCT was measured in plasma samples of heart and lung transplanted patients using a commercial immuno-luminescence assay and was compared with values of C-reactive protein (CRP) and leukocytes (WBC).


RESULTS
PCT was elevated in patients suffering from bacterial and fungal infections. The magnitude of values was clearly associated with the severity of the infection. Rejections and viral infections did not interfere with the PCT release.


CONCLUSIONS
PCT is a reliable predictor with discriminating power for non-viral systemic infections in patients after heart and/or lung transplantation. PCT allows an early differential diagnosis between rejection (AR) and bacterial/fungal infection (IF) and thus a rapid and focused therapeutic intervention. It avoids unnecessary antibiotic treatment which could be toxic for the graft itself in patients with rejection only. PCT provides vital information early to clinicians and allows them to improve the management of bacterial/fungal infections in immunocompromized transplant patients. PCT thus facilitates and improves the outcome of survival rate and the quality of life in the postoperative period of patients with heart and/or lung grafts.
Hammer
S
S
Inst.Surg.Res., Inst.Clin.Chem., Dept.Cardio-Thoracic Surg., IBE, Klinikum Grosshadern, Ludwig-Maximilians-University, D-81366 Munich, Germany.
Meisner
F
F
Dirschedl
P
P
Fraunberger
P
P
Meiser
B
B
Reichart
B
B
Hammer
C
C
D018806:APACHE; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D005260:Female; D005858:Germany; D006084:Graft Rejection / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects; D016041:Heart-Lung Transplantation / Q000009:adverse effects*; D006801:Humans; D007962:Leukocytes / Q000378:metabolism; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D009181:Mycoses / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D011498:Protein Precursors / Q000097:blood*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide