PROCALCITONIN IN THE EARLY PHASE AFTER RENAL-TRANSPLANTATION - WILL IT ADD TO DIAGNOSTIC-ACCURACY

The determination of serum procalcitonin (PCT) was tested for its util ity in detecting invasive bacterial infection and acute rejection duri ng the first 6 wk after kidney transplantation. Fifty-seven kidney gra ft recipients were prospectively included in the study. In 13/57 patie nts, 16 episodes of acute biopsy-proven rejection occurred and were tr eated with high-dose steroids (n = 14) or with OKT3 (n = 2). Seventeen out of 57 patients experienced 19 invasive bacterial infections; 2/57 had partial graft necrosis due to malperfusion. Twenty-five out of 57 graft recipients experienced an uncomplicated postoperative course. A total of 116 samples were analyzed and the following data obtained: P CT, C-reactive protein (CRP), white blood cell (WBC) count, correspond ing body temperature and serum creatinine.Procalcitonin values for pat ients with rejection did not differ significantly from those of the he althy transplant recipients (p = 0.47). In contrast, PCT was clearly e levated with invasive bacterial infection or partial graft necrosis (p < 0.01). OKT3 treatment of rejection led to a more than 10-fold incre ase in PCT. C-reactive protein, unlike PCT, was elevated to a variable extent in patients with graft rejection, though CRP values were signi ficantly more elevated in patients with infection than in those with r ejection (p < 0.01). The specifity for detection of invasive bacterial infection was 0.7 for PCT and 0.43 for CRP, whereas sensitivity was 0 .87 for PCT and 1.0 for CRP. There was no correlation between PCT and serum creatinine (r = 0.06). Haemodialysis did not lower PCT serum con centrations. Procalcitonin values rose postoperatively to peak levels on the first and second days and mostly declined to normals within 1 w k. In conclusion PCT, not being influenced by acute kidney graft rejec tion but serving as a specific indicator of systemic bacterial infecti on, could help to discriminate between both types of inflammation.