Background: Procalcitonin (PCT) has been shown to be an effective biomarker for bacterial sepsis. Its utility has also been noted in post liver transplant patients. However, its effectiveness has yet to be proven in Liver/Small bowel transplant. Research has suggested possible effectiveness in differentiating between acute infection versus rejection. It has also been utilized in managing antibiotics determining time of initiation and duration of therapy.
Methods: A retrospective chart review found 14 patients with PCT levels in the Pediatric Liver and Small Bowel Transplant Program at the University of Nebraska Medical Center during the period of October 2011 to October 2012. PCT values were compared to the work-up completed for each patient to assess for correlating infectious process or rejection. Based on the laboratorys results interpretation, in patients with suspected lower respiratory tract infections (LRTI), antibiotics were encouraged with levels > 0.25 ng/ml. In patients with suspected sepsis, PCT > 0.5 ng/ml, antibiotics were encouraged, and levels >2.0 ng/ml, antibiotics were strongly encouraged.
Results: 86 PCTs were drawn over this period. 9 of the 14 patients were post-multivisceral transplant. 3 of the 14 received isolated small bowel transplants, and 2 received isolated liver transplants. LRTI was suspected in 8 of the 14 patients, with corresponding elevated PCTs. Higher PCTs were noted in patients having concurrent viral and bacterial infections. In 5 patients with suspected sepsis, PCTs correlated well in the initial diagnosis of infection and trended downward with treatment. 1 of the 14 patients presented with acute rejection and concurrent sepsis with elevated PCT. 1 of the patients developed severe acute rejection approximately 2 weeks post isolated small bowel transplant, with no elevation in PCT. The remaining patients did not present with rejection. All of the patient's PCTs improved with antibiotic therapy and/or removal of infected central access.
Discussion: Elevated PCTs correlated well with the presence of an infection. PCT levels trended downward as therapy was initiated in our post-liver/small bowel transplant population. PCT could be a useful marker in managing antibiotics, as well as a minimally invasive marker to rule out rejection for Liver and/or Small Bowel transplant.
To cite this abstract in AMA style:Lirio R, Trauernicht A, Chaplin R, Grant W, Langnas A, Quiros-Tejeira R. Utility of Procalcitonin in Differentiating Infection from Rejection in Pediatric Liver-Small Bowel Transplant Patients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/utility-of-procalcitonin-in-differentiating-infection-from-rejection-in-pediatric-liver-small-bowel-transplant-patients/. Accessed May 6, 2021.
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