Procalcitonin in fever of unknown origin after liver transplantation: a variable to differentiate acute rejection from infection.

Objective: Does procalcitonin (PCT) differentiate between infection and rejection after liver transplantation in patients with fever of unknown origin? Design: Open prospective trial. Setting: Transplant intensive care unit at a university hospital. Patients: Forty patients after liver transplantation. Interventions: Liver biopsy for the diagnosis of rejection and transcutaneous aspiration cytology for monitoring of lymphocyte activation. Measurements: Procalcitonin from EDTA plasma, Acute Physiology and Chronic Health Evaluation II, and sepsis score. Results: Eleven patients experienced an infectious complication resulting in an increase in PCT concentrations (2.2-41.7 ng/mL). Eleven patients had a rejection episode; none of these patients showed a rise in PCT concentrations. The statistical difference between PCT concentrations in rejection and infection was significant (p <.05) on the day of diagnosis. Conclusion: PCT allows for differentiation between rejection and infection in patients with fever of unknown origin. Elevation of PCT plasma concentrations develops early postoperatively from operation trauma, and in the case of fever of unknown origin, with no rise in PCT, a rejection may be suspected.