Procalcitonin for differential diagnosis of graft rejection and infection in patients with heart and/or lung grafts

Hammer, S.; Meisner, F.; Dirschedl, P.; Fraunberger, P.; Meiser, B.; Reichart, B.; Hammer, C.

Objectives: Investigation of the reliability of Procalcitonin (PCT) for differential diagnosis of acute rejections and non-viral infections in heart and lung transplanted patients.¶Design: Retrospective study.¶Setting: Transplant intensive care unit (ICU) at a university hospital.¶Patients: 57 heart, 18 lung and 3 heart-lung transplant patients.¶Measurements: PCT was measured in plasma samples of heart and lung transplanted patients using a commercial immuno-luminescence assay and was compared with values of C-reactive protein (CRP) and leukocytes (WBC).¶Results: PCT was elevated in patients suffering from bacterial and fungal infections. The magnitude of values was clearly associated with the severity of the infection. Rejections and viral infections did not interfere with the PCT release.¶Conclusion: PCT is a reliable predictor with discriminating power for non-viral systemic infections in patients after heart and/or lung transplantation. PCT allows an early differential diagnosis between rejection (AR) and bacterial/fungal infection (IF) and thus a rapid and focused therapeutic intervention. It avoids unnecessary antibiotic treatment which could be toxic for the graft itself in patients with rejection only. PCT provides vital information early to clinicians and allows them to improve the management of bacterial/fungal infections in immunocompromized transplant patients. PCT thus facilitates and improves the outcome of survival rate and the quality of life in the postoperative period of patients with heart and/or lung grafts.