Analysis of systemic and regional procalcitonin serum levels during liver transplantation

Abstract

Elevated procalcitonin (PCT) levels are observed early after orthotopic liver transplantation (OLTx). The aim of this study was to evaluate the changes in systemic and regional PCT serum levels from the time of organ harvesting until the early postoperative phase of OLTx ( n=28) and to investigate the prognostic suitability of postoperative changes in PCT level for the outcome of OLTx ( n=61). Only in seven of 28 donors were higher PCT levels found (0.84+/-0.43 ng/ml). During organ preservation, hepatectomy, and in the anhepatic phase, the PCT levels were in the normal range; in 11 of 28 cases hepatic vein PCT levels were higher during graft flush with own blood than the systemic or portal vein samples at the same time (1.27+/-0.43 ng/ml vs 0.16+/-0.26 ng/ml and 0.23+/-0.15 ng/ml, respectively, P<0.02). The elevation of PCT levels began immediately after graft reperfusion (1.04+/-0.77 ng/ml vs 0.27+/-0.22 ng/ml, P<0.001), and the levels at postoperative day 2 were significantly higher in the case of postoperative complications (30.6+/-19.6 ng/ml vs 4.8+/-3.6 ng/ml, P<0.001).

The Role of Procalcitonin in the Early Diagnosis of Septic and Non-Septic Complications in the Immediate Postoperative Setting After Orthotopic Liver Transplantation

“…Eyraud et al [43] investigated also the relevance of PCT in the posttransplant setting after OLT. The results of this study could not confirm them of previous studies [58,59] reporting that peak PCT could have its origin either from an infection of the recipient or from cardiac arrest of the donor. In this study the clinical characteristics of the donor are emphasized: the initial PCT of recipient has its origin from donor's cardiac arrest and it could not be predictive of graft dysfunction or postoperative complications after OLT.…”

“…Furthermore graft preservation, graft flushing and type of reperfusion are factors, which have a significant influence on initial PCT values and this is one of the main bias as far as the sensitivity of PCT in the early posttransplant phase is concerned. Therefore Fazakas et al proposed standard procedures for graft harvesting, timing and technique of graft flushing in order to avoid the pathophysiological conditions, which lead to this bias [59].…”

Analysis of differences in outcome of two European liver transplant centers

“…anesthesia (using sufentanil, midazolam, and vercuronium) with volume‐controlled ventilation was provided [17]. In SEB, the induction was performed with etomidate, fentanyl or alfentanyl and atracurium and maintained with fentanyl, isoflurane, atracurium and dopamine [18–20]. Both centers used aprotinine for reduction of fibrinolysis as described by Porte et al [21].…”

“…SEB also used the Tonocap (DATEX) for the evaluation of the regional perfusion of the gastric mucosa (PHI) [19]. Thrombelastography was used in both centers intraoperatively to assess the coagulation status [18,20,22]. In the UMCG, RBC replacement was carried out to maintain a hematokrit between 0.25 and 0.30 [17,21], while in SEB it was 0.30.…”

“…Implantation was performed in both centers by the conventional technique described by Starzl as well as the piggyback technique [23,24]. In the UMCG, all conventional OLTs were performed with a veno‐venous bypass (VVB) while in SEB the VVB was used selectively in conventional OLT cases [18,25]. In both centers, an end to end portal vein reconstruction, with a continuous suture and growth factor, was performed.…”