Procalcitonin -: a new diagnostic tool in complications following liver transplantation

Objective: Does procalcitonin (PCT) allow differentiation between infection and rejection following liver transplantation in the case of fever of unknown origin (FUO)? Design: Open prospective trial. Setting: transplant intensive care unit at a university hospital. Patients: Forty patients after liver transplantation. Interventions: Liver biopsy for diagnosis of rejection, transcutaneous aspiration cytology for monitoring of lymphocyte activation. Measurements: Procalcitonin from EDTA plasma, APACHE II, Sepsis score (Elbute and Stoner). Results: Eleven patients suffered an infectious complication resulting in an increase in PCT levels (2.2-41.7 ng/ml). Eleven patients developed a rejection episode; none of these patients showed a rise in PCT levels. The statistical difference between PCT levels in rejection and infection was significant (p < 0.05) on the day of diagnosis. Conclusion: PCT allows differentiation between rejection and infection in the case of FUO. Elevation of PCT plasma levels develops early postoperatively due to operation trauma, and, in the case of FUO with no rise in PCT, a rejection may be suspected.