Eyraud Daniel, Ben Ayed Saïd, Tanguy Marie Laure, Vézinet Corinne, Siksik Jean Michel, Bernard Maguy, Fratéa Sylvia, Movschin Marie, Vaillant Jean-Christophe, Coriat Pierre, Hannoun Laurent
Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière 43-47 Boulevard de l'Hôpital, 75013 Paris, France.
Crit Care. 2008;12(4):R85. doi: 10.1186/cc6942. Epub 2008 Jul 4.
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.
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.
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.
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.
迄今为止，临床实践中尚无用于评估和预测肝移植患者临床病程或并发症的特异性标志物。已发现感染性炎症中降钙素原（PCT）水平升高；心脏供体中器官灌注不良和PCT水平升高似乎可预测早期移植失败。我们评估了PCT作为早期移植功能障碍和术后并发症预测指标的价值。
在67例连续脑死亡供体器官获取前采集的样本中以及相应受者从肝移植前第0天直至肝移植后第7天测量PCT血清浓度。在供体中记录以下参数：血管活性药物剂量、获取前24小时心脏骤停史、重症监护病房住院天数、供体年龄以及供体感染情况，在受者中记录以下参数：冷缺血和热缺血时间、静脉 - 静脉转流、原位肝移植（OLT）期间输血量以及术后并发症或肝功能障碍的发生情况。
在供体中，术前PCT水平与器官获取前心脏骤停和高剂量儿茶酚胺有关。在受者中，OLT后早期观察到PCT水平升高，在OLT后第1天或第2天达到峰值，然后下降直至第7天。PCT水平术后峰值既不与供体或受者术前PCT水平相关，也不与OLT后肝功能障碍或其他术后并发症相关，而是与两个供体参数相关：感染和心脏骤停。
供体PCT水平和受者早期PCT峰值不能预测OLT后肝功能障碍或其他并发症。供体的心脏骤停和感染，而非供体PCT水平，与受者OLT后高PCT水平相关。
