Perrakis A, Yedibela S, Schellerer V, Hohenberger W, Müller V
Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
Transplant Proc. 2010 Dec;42(10):4187-90. doi: 10.1016/j.transproceed.2010.08.070.
Orthotopic liver transplantation (OLT) is a treatment for end-stage liver disease. The shortage of available organs leads to the acceptance of marginal grafts, thereby increasing the risk of perioperative complications such as acute rejection, infection, and graft dysfunction Procalcitonin (PCT) has been shown to be a reliable marker for a complicated course after traumatic injury as well as in the courses of systemic inflammatory response syndrome and sepsis. The aim of our study was to evaluate PCT as an early prognostic marker for the occurrence of complication during the postoperative course after OLT.
We analyzed PCT levels and clinical and paraclinical data of 32 patients who underwent 33 OLTs. The highest PCT was termed as peak-PCT. Patients were stratified into noncomplication and complication groups. Renal replacement therapy, respiratory insufficiency, postoperative bleeding, refractory ascites, pleural effusion, rejection, sepsis, and fatal outcome were defined as complications. A secondary stratification, using a peak-PCT of 5 ng/mL, was used to analyzed the risk of a complication. We also analyzed the course of PCT after OLT in each group.
The peak-PCT, which occurred between the first and third postoperative day in 30 patients, was followed by halving of the value every second day. Three subjects died because of sepsis. A constantly rising PCT or a secondary rise observed in 2 patients was associated with a fatal outcome. The noncomplication group included 18 patients, 8 of them showing a peakPCT <5 ng/mL and 10 above. The complication group included 14 patients who underwent 15 transplantations; Only 1 displayed a peakPCT <5 ng/mL. When the peak-PCT was >5 ng/mL, the odds ratio of a complication was 11.2 (95% Confidence interval, 10.81-11.59; P < .025). However, not before the 7th postoperative day was the course of mean PCT levels significantly different between the complication and noncomplication groups. In transplant patients, an elevation of PCT was observed only in the presence of bacterial infection and not rejection or wound infection. PCT rose during respiratory failure and sepsis, but not renal replacement therapy, ascites, pleural effusion, rejection, or bleeding.
PCT was a reliable marker. A decline was observed in 31 cases with subject, who both had fatal outcomes showing a constantly rising level. An initial high PCT indicated a poor prognosis; some members of the noncomplication group also had levels >15 ng/mL. The patients in the complication group showed a higher mean PCT, which was significant at 7 days, most probably because of the high variation among levels. Still, a peak-PCT >5 ng/mL showed an odds ratio of 11.2 for patients to experience a complication.
原位肝移植（OLT）是治疗终末期肝病的一种方法。可用器官的短缺导致接受边缘性移植物，从而增加围手术期并发症的风险，如急性排斥反应、感染和移植物功能障碍。降钙素原（PCT）已被证明是创伤性损伤后以及全身炎症反应综合征和脓毒症病程中复杂病程的可靠标志物。我们研究的目的是评估PCT作为OLT术后并发症发生的早期预后标志物。
我们分析了32例行33次OLT患者的PCT水平以及临床和辅助检查数据。最高PCT被称为峰值PCT。患者被分为无并发症组和并发症组。肾替代治疗、呼吸功能不全、术后出血、难治性腹水、胸腔积液、排斥反应、脓毒症和死亡结局被定义为并发症。使用5 ng/mL的峰值PCT进行二次分层，以分析并发症风险。我们还分析了每组OLT后PCT的变化过程。
30例患者的峰值PCT出现在术后第1天至第3天之间，随后每隔一天值减半。3名患者因脓毒症死亡。2例患者观察到PCT持续升高或二次升高与死亡结局相关。无并发症组包括18例患者，其中8例峰值PCT<5 ng/mL，10例高于此值。并发症组包括14例接受15次移植的患者；只有1例峰值PCT<5 ng/mL。当峰值PCT>5 ng/mL时，并发症的比值比为11.2（95%置信区间，10.81 - 11.59；P<.025）。然而，直到术后第7天，并发症组和无并发症组之间的平均PCT水平变化过程才存在显著差异。在移植患者中，仅在存在细菌感染时观察到PCT升高，而排斥反应或伤口感染时未观察到。呼吸衰竭和脓毒症时PCT升高，但肾替代治疗、腹水、胸腔积液、排斥反应或出血时未升高。
PCT是一个可靠的标志物。31例患者中观察到下降，其中有致命结局的患者PCT水平持续升高。初始PCT水平高表明预后不良；无并发症组的一些成员PCT水平也>15 ng/mL。并发症组患者的平均PCT较高，在第7天时具有显著性，很可能是因为各水平之间差异较大。尽管如此，峰值PCT>5 ng/mL的患者发生并发症的比值比为11.2。
