Research

Procalcitonin in liver transplantation: are high levels due to donors or recipients?

Daniel Eyraud¹ , Saïd Ben Ayed² , Marie Laure Tanguy³ , Corinne Vézinet¹ , Jean Michel Siksik⁴ , Maguy Bernard² , Sylvia Fratéa¹ , Marie Movschin¹ , Jean-Christophe Vaillant⁴ , Pierre Coriat¹ and Laurent Hannoun⁴

¹Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière 43-47 Boulevard de l'Hôpital, 75013 Paris, France

²Laboratoire de Biochimie, Hôpital Pitié-Salpêtrière 43-47 Boulevard de l'Hôpital, 75013 Paris, France

³Unité de Recherche Clinique, département de Statistiques, Hôpital Pitié-Salpêtrière 43-47 Boulevard de l'Hôpital, 75013 Paris, France

⁴Service de chirurgie digestive et de transplantation hépatique, Hôpital Pitié-Salpêtrière 43-47 Boulevard de l'Hôpital, 75013 Paris, France

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Critical Care 2008, 12:R85doi:10.1186/cc6942

Published:	4 July 2008

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.