Institute of Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Surgery and Transplantation, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
BMC Gastroenterol. 2022 Aug 31;22(1):404. doi: 10.1186/s12876-022-02486-5.
Ischemia-reperfusion injury (IRI) is the pathophysiological hallmark of hepatic dysfunction after orthotopic liver transplantation (OLT). Related to IRI, early allograft dysfunction (EAD) after OLT affects short- and long-term outcome. During inflammatory states, the liver seems to be the main source of procalcitonin (PCT), which has been shown to increase independently of bacterial infection. This study investigates the association of PCT, IRI and EAD as well as the predictive value of PCT during the first postoperative week in terms of short- and long-term outcome after OLT.
Patients ≥ 18 years undergoing OLT between January 2016 and April 2020 at the University Hospital of Zurich were eligible for this retrospective study. Patients with incomplete PCT data on postoperative days (POD) 1 + 2 or combined liver-kidney transplantation were excluded. The PCT course during the first postoperative week, its association with EAD, defined by the criteria of Olthoff, and IRI, defined as aminotransferase level > 2000 IU/L within 2 PODs, were analysed. Finally, 90-day as well as 12-month graft and patient survival were assessed.
Of 234 patients undergoing OLT, 110 patients were included. Overall, EAD and IRI patients had significantly higher median PCT values on POD 2 [31.3 (9.7-53.8) mcg/l vs. 11.1 (5.3-25.0) mcg/l; p < 0.001 and 27.7 (9.7-51.9) mcg/l vs. 11.5 (5.5-25.2) mcg/l; p < 0.001] and impaired 90-day graft survival (79.2% vs. 95.2%; p = 0.01 and 80.4% vs. 93.8%; p = 0.033). IRI patients with PCT < 15 mcg/l on POD 2 had reduced 90-day graft and patient survival (57.9% vs. 93.8%; p = 0.001 and 68.4% vs. 93.8%; p = 0.008) as well as impaired 12-month graft and patient survival (57.9% vs. 96.3%; p = 0.001 and 68.4% vs. 96.3%; p = 0.008), while the outcome of IRI patients with PCT > 15 mcg/l on POD 2 was comparable to that of patients without IRI/EAD.
Generally, PCT is increased in the early postoperative phase after OLT. Patients with EAD and IRI have a significantly increased PCT maximum on POD 2, and impaired 90-day graft survival. PCT measurement may have potential as an additional outcome predictor in the early phase after OLT, as in our subanalysis of IRI patients, PCT values < 15 mcg/l were associated with impaired outcome.
肝移植（OLT）后肝功能障碍的病理生理标志是缺血再灌注损伤（IRI）。与 IRI 相关的OLT 后早期移植物功能障碍（EAD）会影响短期和长期结果。在炎症状态下，肝脏似乎是降钙素原（PCT）的主要来源，已经证明 PCT 水平独立于细菌感染而升高。本研究调查了 PCT、IRI 和 EAD 之间的关联，以及在 OLT 后第一周内 PCT 的预测价值，以评估其对短期和长期结果的影响。
在苏黎世大学医院接受 OLT 的年龄≥18 岁的患者有资格参加这项回顾性研究。排除术后第 1 天（POD）1+2 天 PCT 数据不完整或联合肝-肾移植的患者。分析了第 1 个术后周 PCT 曲线、EAD（Olthoff 标准定义）和 IRI（定义为术后 2 天内转氨酶水平>2000IU/L）的相关性。最后，评估了 90 天和 12 个月的移植物和患者存活率。
在 234 名接受 OLT 的患者中，有 110 名患者纳入本研究。总体而言，EAD 和 IRI 患者在 POD2 的 PCT 值中位数明显更高[31.3（9.7-53.8）mcg/l 与 11.1（5.3-25.0）mcg/l；p<0.001 和 27.7（9.7-51.9）mcg/l 与 11.5（5.5-25.2）mcg/l；p<0.001]，90 天移植物存活率也受损[79.2%与 95.2%；p=0.01 和 80.4%与 93.8%；p=0.033]。在 POD2 时 PCT<15mcg/l 的 IRI 患者 90 天移植物和患者存活率降低（57.9%与 93.8%；p=0.001 和 68.4%与 93.8%；p=0.008），12 个月移植物和患者存活率也受损（57.9%与 96.3%；p=0.001 和 68.4%与 96.3%；p=0.008），而在 POD2 时 PCT>15mcg/l 的 IRI 患者的结果与无 EAD/IRI 的患者相当。
一般来说，OLT 后早期 PCT 水平升高。EAD 和 IRI 患者在 POD2 的 PCT 最大值显著升高，90 天移植物存活率受损。PCT 测量可能具有作为 OLT 后早期附加预后预测因子的潜力，在我们对 IRI 患者的亚分析中，PCT 值<15mcg/l 与预后不良相关。
