Features of the use of sepsis biomarkers after liver transplantation

Background. Liver transplantation is the only radical treatment for end-stage liver diseases; however, postoperative infectious complications, particularly sepsis, significantly worsen prognosis and increase mortality. Sepsis after liver transplantation develops in 20–40% of recipients and is associated with high mortality (up to 50%), which is caused by immunosuppressive therapy, surgical trauma, and the baseline severity of the patient's condition.

Objective. To provide a literature review on sepsis biomarkers after liver transplantation.

Material and methods. Analysis of scientific publications in PubMed, Google Scholar, and Medline databases for the period 2015–2025 on the topic of sepsis biomarkers after liver transplantation.

Results. The main groups of sepsis biomarkers after liver transplantation were identified and systematized: immunological (T-cell clonality, sTREM-1, presepsin, cytokines), biochemical (procalcitonin, hyaluronic acid, bilirubin, INR), hematological (neutrophil-lymphocyte ratio, platelets), genetic and epigenetic (microRNA, long non-coding RNA). Combined prediction algorithms using clinical scales (SOFA, MELD) and machine learning methods were analyzed.

Conclusion. Current data indicates significant prognostic potential of sepsis biomarkers after liver transplantation. The most promising direction is the combination of immunological (T-cell clonality, sTREM-1) and biochemical (PCT, HA) markers, integration of traditional scales (SOFA, MELD) with machine learning algorithms, and the use of genetic and epigenetic markers for a personalized approach. Implementation of these approaches in clinical practice will significantly improve outcomes in liver recipients through early diagnosis of sepsis, timely initiation of therapy, and personalized immunosuppressive treatment.

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