Differentiated therapy with prostaglandin E1 (Alprostadil) after orthotopic liver transplantation: the usefulness of procalcitonin (PCT) and hepatic artery resistive index (RI) for the evaluation of early graft function and clinical course

Increasing demand for donor organs has led to new pharmacological concepts for reducing ischemia-reperfusion injury (I/R) of the graft after liver tra nsplantation to prevent primary non-functioning of the organ. Prostaglandin s have proved to be cytoprotective in several experimental models of ischem ia and transplantation. The prophylactic administration after orthotopic li ver transplantation is still a subject of controversial discussion. The aim of our study was the evaluation of the post-transplant hepatic artery resi stive index (RI) measured by color Doppler imaging, in combination with pos toperative elevation of transaminases, as parameters indicating the need fo r a differentiated systemic therapy with prostaglandin E1 (PGE1) (alprostad il). In addition, the value of serum procalcitonin (PCT) as a postoperative parameter for the extent of I/R is investigated. In the case of post-trans plant elevated hepatic artery RI (RI > 0.75). the administration of PGE1 le d to a significant reduction of transaminases (p < 0.05) and a decline of t he RI. In addition, postoperative PCT levels could be reduced significantly by PGE1 application. These results suggest that determination of RI is fea sible for indicating a need for therapy with PGE1. Its targeted application reduces hepatocellular damage due to I/R after liver transplantation.