METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
方法:2016年1月至2020年4月期间在苏黎世医院接受OLT的≥18岁患者符合这项回顾性研究的条件。排除术后第1天(POD)1+2天PCT数据不完整或肝肾联合移植的患者。术后第一周的PCT疗程,它与EAD的联系,由Olthoff的标准定义,还有IRI,定义为2个POD内的转氨酶水平>2000IU/L,进行了分析。最后,评估90天以及12个月的移植物和患者存活率。
结果:在234例接受OLT的患者中,包括110名患者。总的来说,EAD和IRI患者在POD2上的PCT中值明显较高[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]和90天移植物存活率受损(79.2%vs.95.2%;p=0.01和80.4%vs.93.8%;p=0.033)。在POD2上PCT<15mcg/l的IRI患者的90天移植物和患者生存率降低(57.9%vs.93.8%;p=0.001和68.4%与93.8%;p=0.008)以及12个月移植物和患者生存率受损(57.9%vs.96.3%;p=0.001和68.4%vs.96.3%;p=0.008),而在POD2上PCT>15mcg/l的IRI患者的预后与无IRI/EAD的患者相当。
结论:一般来说,OLT术后早期PCT升高。EAD和IRI患者在POD2上的PCT最大值显着增加,并且90天的移植物存活受损。PCT测量可能在OLT后的早期阶段作为额外的结果预测因子,就像我们对IRI患者的亚分析一样,PCT值<15mcg/l与预后受损相关。