Serum procalcitonin levels immediately after living donor liver transplantation: the potential predictor of short-term positive blood cultures and graft loss

Abstract

【Objective】 Serum procalcitonin (PCT) levels transiently elevate during the first few days after both living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT). Although the impact of early-phase serum PCT levels on DDLTs has been researched in other literature, that on LDLTs is still not well clarified.

【Design】 A single-institutional retrospective cohort.

【Methods】 A total of 233 adult primary liver transplantations (205 LDLTs and 28 DDLTs) between 2013 and 2022 were analyzed. Thirty-seven cases were excluded due to the lack of data. We evaluated the first-week transition in serum PCT levels. The impact of serum PCT levels on positive blood cultures of gut microbiota and 1-year graft survival was also analyzed.

【Results】 Pre-transplant serum PCT levels were significantly correlated with the Model for End-Stage Liver Disease score. Serum PCT levels peaked at postoperative day (POD) 2, and the average serum PCT levels at PODs 1-3 were higher in DDLTs (1.99 vs. 11.02 ng/mL, p<0.01). LDLT recipients with high average serum PCT levels at PODs 1-3 (>10 ng/mL) had a lower positive blood culture-free survival within 14 days (70.6 vs. 94.3%, p<0.01). The high average serum PCT levels at PODs 1-3 (>10 ng/mL) were also a significant factor in 1-year graft loss in LDLTs (hazard ratio = 4.17, p=0.03).

【Conclusion】 High serum PCT levels at PODs 1-3 may be a potential predictor of short-term positive blood cultures and graft loss in LDLTs.