Kinetic of Procalcitonin in the Early Postoperative Course Following Heart Transplantation

Background: It was the aim of the study to determine the kinetics of procalcitonin (PCT) levels following heart transplantation (HTx) and to investigate the prognostic suitability of postoperative changes in PCT levels for patients' outcome. Methods: 52 adult heart transplant recipients were divided into two groups according to their in-hospital postoperative outcome retrospectively. Group A (eventful ± nonsurvivors) of 24 patients (21 males, three females, mean age 54.5 ± 10.1 years) was compared with Group B (uneventful) of 28 patients (22 males, six females, mean age 53.6 ± 8.1 years). Results: Serum PCT levels were measured before and daily after operation until day seven. Demographic data, operative data, and clinical endpoints (mortality, infection, severe complication) were analyzed. Mean PCT levels immediately before HTx were <0.3 ng/mL in both groups, respectively. PCT increased with maximum concentrations on the second post-operative day (Group A: 54.6 ± 44.3 ng/mL; Group B: 9.1 ± 9.3 ng/mL). After day two the levels decreased to 7.8 ± 8.8 ng/mL in Group A and 0.6 ± 0.8 ng/mL in Group B on day seven. Postoperative PCT was increased in nonsurvivors compared to survivors in Group A (81.6 ± 58.7 ng/mL vs 44.7 ± 19.8 ng/ml; p < 0.05). Conclusions: PCT levels have been consistently low (<10 ng/mL) in patients with an uneventful course, but more frequently increased in patients with postoperative complications and even associated with an increased mortality early postoperatively when values exceed 80 ng/mL. As a clinical consequence, PCT levels in the first few days following cardiac transplantation can help to identify patients at risk, when concentrations exceed the “normal” posttransplant range.