الفهرس 
Infection in living donor liver transplantationOnly 14 pages are availabe for public view
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Abstract
The aim of the present study is to evaluate the role of serum procalcitonin as an infection parameter in diagnosis and management of non-viral infection post living donor liver transplantation among Egyptian recipients, and to study its ability for early differentiation between infection and rejection and also between SIRS, sepsis and severe sepsis conditions.
The study was conducted on 50 adult cases of living donor liver transplantation that were categorized according to laboratory, bacteriological and histopathological findings into 25 patients with infection and 25 patients with rejection. Cases were split also according to American College of Chest Physicians (ACCP) / Society of Critical Care Medicine (SCCM) Consensus Conference definition of sepsis into 10 non SIRS cases, 15 cases with SIRS, 18 cases with sepsis, and 7 cases with severe sepsis.
HCV related end stage liver disease was the main indication for LDLT among the studied patients accounting for 88% .
Pulmonary infection was the commonest site of infection being diagnosed in 40% of patients in infection group with gram negative bacteria were the commonest organisms isolated (56%).
Biliary complications were the commonest morbidity following LDLT in our series being observed in 34% of the patients and it had no significant impact on incidence of infection or rejection.
A higher incidence and earlier onset of infection was associated with lower GRWR where most of patients with acute infection occurred in the first 3 weeks post operative and had a GRWR ranging from 0.8 to 0.9.
All recipients in our series showed an elevation of PCT immediately post operative due to surgical trauma, with normalization of PCT occurred at the 3rd POD in 68% of patients. A prolonged duration of high PCT post operative was associated with adverse intraoperative events, but this duration was not exceeding the 5th POD, a longer duration observed in 12% of the recipients and was an early predictor of infection.
As regard clinical data, body temperature was not a reliable sign of infection, however, tachycardia, tachyapnea, and lower mean blood pressure were a significant signs of infection.
Procalcitonin was able to diagnose infection with 64% sensitivity and 100% specificity at a cut off value of 2 ng/ml. CRP had the same ability with 72% sensitivity and much lower specificity (68%) at a cut off value of 18 mg/L. On the other hand only PCT had a prognostic ability with early evaluation of treatment response.
There was no significant relation between PCT level done at beginning of infection and the site of infection or organism isolated.
Procalcitonin was the only marker in our study that could efficiently differentiate between non SIRS, SIRS, sepsis, and severe sepsis cases.