Hepatitis Monthly
Volume:19 Issue: 5, May 2019

Procalcitonin (PCT) has been shown as a reliable diagnostic biomarker for identifying sepsis and bacterial infection. The present study examined the sensitivity and specificity of PCT evaluation in the diagnosis of infectious diseases after liver transplantation. The present prospective cohort study was conducted on postoperative liver transplant (LT) patients in the liver transplant ward of Imam Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences between January 2014 and March 2015. Serum PCT levels were evaluated before transplantation and one, two, and six or seven days post-operation by semi-quantitative kits with a 30 seconds response. A total number of 28 LT patients were enrolled in this study. The mean patients’ ages were 48.6 ± 10.9 (range 26 - 66) years old. Serum PCT levels in all patients were < 0.5 ng/mL prior to the operation. At first and second days post-operation, PCT levels were more than 2 ng/mL in all patients and decreased to 0.5 ng/mL after 6 or 7 days in 23 patients. Serum PCT level of higher than 5 ng/mL on the first and second days post-surgery with a sensitivity of 77.8% and specificity of 79% had the most accuracy for the infection diagnosis. The PCT level more than 5 ng/mL in the sixth and seventh days had a 100% positive predictive value in the infection prediction. Serial evaluations of serum PCT after liver transplantation had good sensitivity and specificity to predict postoperative infection. Increased serum PCT level within the first days after transplantation and/or failure to decrease after one week, predicts infectious complications and undesirable outcome.

Liver is one the most common sites of metastasis, and metastatic liver cancers are the most common liver malignancies. Metastatic adenocarcinomas are the most common metastatic liver cancers, which have different origins. The liver biopsy is a very important step to find the origin of metastatic cancer by immunohistochemistry. In this study, we aimed to find the primary origin of metastatic adenocarcinomas in the liver biopsies. In this study, 210 liver biopsies with the primary diagnosis of metastasis with unknown origin in the liver were investigated from 2008 to 2017 that 126 cases (60%) of which have proved to be metastatic adenocarcinoma with unknown origin. Histologic studies and immunohistochemical (IHC) stains were performed. Also, a complete endoscopic, radiologic, clinical, and paraclinical studies were carried out besides the liver biopsy to find the origin of the adenocarcinoma. Among these 126 liver biopsies, the origin of 94 cases (74.6%) was definitely determined by IHC and other examinations mentioned above. All efforts for thirty-two cases (25.4%) failed to find the primary origin despite a complete examination. Most common primary origins were colon (23.8%), lung (19%), pancreas (13.9%), and breast (11.2%). Performing a liver biopsy is a very helpful modality to find the origin of liver metastatic adenocarcinoma but needs to be combined with other clinical findings and diagnostic modalities to find the origin of metastasis to the liver. By combining these methods, our study showed that the origin of 74.6% of metastatic liver adenocarcinomas can be found, which is most commonly from colon, lung, and pancreas.