Research
Induction of procalcitonin in liver transplant patients treated with anti-thymocyte globulin
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* Corresponding author: Roman Zazula roman.zazula@ftn.cz
1 Department of Anesthesiology and Intensive Care, Charles University in Prague, the First Faculty of Medicine and Thomayer's Faculty Hospital, Videnska 800, 140 59 Prague, Czech Republic
2 Department of Clinical Biochemistry, Hematology and Immunology, Hospital Na Homolce, Roentgenova 2, 150 30 Prague, Czech Republic
3 Department of Anesthesiology and Intensive Care, Institute for Experimental and Clinical Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
Critical Care 2007, 11:R131 doi:10.1186/cc6202
Published: 18 December 2007Abstract
Introduction
The aim of this study was to compare the early postoperative kinetics of procalcitonin (PCT) and C-reactive protein (CRP) serum levels in patients undergoing orthotopic liver transplantation (OLTx) with different immunosuppressive regimens.
Methods
PCT and CRP serum concentrations were measured in a group of 28 OLTx recipients before induction of anesthesia, at 4 and 8 hours following graft reperfusion, and daily until postoperative day 4. The same parameters were determined in 12 patients undergoing liver resection without conjunctive immunosuppressive therapy. Summary data are expressed as medians and ranges. Two-tailed nonparametric tests were performed and considered significant at p values of less than 0.05.
Results
The highest serum levels of PCT (median 3.0 ng/mL, minimum 1.4 ng/mL, maximum 13.9 ng/mL) were found in patients after OLTx without ATG therapy, on postoperative day 1. In patients with ATG administration, PCT levels were highly increased on postoperative day 1 (median 53.0 ng/mL, minimum 7.9 ng/mL, maximum 249.1 ng/mL). Thereafter, PCT values continuously decreased independently of further ATG administration in both groups of patients. No evidence of infection was present in either group. In 12 patients undergoing liver resection, peak serum PCT levels did not exceed 3.6 ng/mL. CRP serum levels in a group of patients with and without ATG therapy increased significantly on postoperative day 1, followed by a decrease. The highest levels of CRP were found in patients after liver resection on postoperative day 2 and decreased thereafter.
Conclusion
ATG administration to patients with OLTx is associated with an increase in serum PCT levels, with peak values on postoperative day 1, and this was in the absence of any evidence of infection. The results of this study indicate that ATG immunosuppressive therapy is a stimulus for the synthesis of PCT.