Procalcitonin in liver transplantation: are high levels due to donors or recipients?
BACKGROUND
To date, a specific marker to evaluate and predict the clinical course or complication of the liver-transplanted patient is not available in clinical practice. Increased procalcitonin (PCT) levels have been found in infectious inflammation; poor organ perfusion and high PCT levels in the cardiac donor appeared to predict early graft failure. We evaluated PCT as a predictor of early graft dysfunction and postoperative complications.


METHODS
PCT serum concentrations were measured in samples collected before organ retrieval from 67 consecutive brain-dead donors and in corresponding recipients from day 0, before liver transplantation, up to day 7 after liver transplantation. The following parameters were recorded in donors: amount of vasopressive drug doses, cardiac arrest history 24 hours before retrieval, number of days in the intensive care unit, age of donor, and infection in donor, and the following parameters were recorded in recipients: cold and warm ischemia time, veno-venous bypass, transfusion amount during orthotopic liver transplantation (OLT), and occurrence of postoperative complication or hepatic dysfunction.


RESULTS
In the donor, the preoperative level of PCT was associated with cardiac arrest and high doses of catecholamines before organ retrieval. In the recipient, elevated PCT levels were observed early after OLT, with a peak at day 1 or 2 after OLT, then a decrease until day 7. A postoperative peak of PCT levels was associated neither with preoperative PCT levels in the donor or the recipients nor with hepatic post-OLT dysfunction or other postoperative complications, but with two donor parameters: infection and cardiac arrest.


CONCLUSIONS
PCT level in the donor and early PCT peak in the recipient are not predictive of post-OLT hepatic dysfunction or other complications. Cardiac arrest and infection in the donor, but not PCT level in the donor, are associated with high post-OLT PCT levels in the recipient.
Eyraud
Daniel
D
Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière 43-47 Boulevard de l'Hôpital, 75013 Paris, France. daniel.eyraud@psl.aphp.fr
Ben Ayed
Saïd
S
Tanguy
Marie Laure
ML
Vézinet
Corinne
C
Siksik
Jean Michel
JM
Bernard
Maguy
M
Fratéa
Sylvia
S
Movschin
Marie
M
Vaillant
Jean-Christophe
JC
Coriat
Pierre
P
Hannoun
Laurent
L
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D014019:Tissue Donors; D014180:Transplantation / Q000009:adverse effects / Q000502:physiology*
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide