Abstract：
BACKGROUND: Ischemia-reperfusion injury (IRI) is the pathophysiological hallmark of hepatic dysfunction after orthotopic liver transplantation (OLT). Related to IRI, early allograft dysfunction (EAD) after OLT affects short- and long-term outcome. During inflammatory states, the liver seems to be the main source of procalcitonin (PCT), which has been shown to increase independently of bacterial infection. This study investigates the association of PCT, IRI and EAD as well as the predictive value of PCT during the first postoperative week in terms of short- and long-term outcome after OLT.
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.
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.
摘要：
背景：缺血再灌注损伤（IRI）是原位肝移植（OLT）后肝功能障碍的病理生理标志。与IRI有关,OLT后早期同种异体移植功能障碍(EAD)影响短期和长期预后.在炎症状态下,肝脏似乎是降钙素原（PCT）的主要来源，已被证明独立于细菌感染而增加。本研究调查了PCT，IRI和EAD以及术后第一周PCT对OLT术后短期和长期预后的预测价值。
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。
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。
