Protein S in end stage liver disease and in the course of liver transplantation

Protein S (PS) is mainly synthesized in the liver and in endothelial cells. Determination of PS levels is complicated by the fact that total PS antigen (total PS Ag) exists in plasma as free and functionally active protein (free PS Ag) and in a reversible inactive complex with C4b-binding protein. In blood samples from patients with end stage liver diseases we studied PS levels before, during and after orthotopic liver transplantation (OLT). Median levels of total and free PS Ag were below and within the lower part of the reference interval, respectively. Two different groups in PS distribution could be distinguished. In 70% of the patients with preoperative levels of total and free PS Ag within the reference interval showed an impaired free/total PS Ag ratio towards higher unbound and free PS Ag levels. With reperfusion of the graft liver total and free PS Ag decreased significantly and the free/total PS Ag ratio normalized. In 30% of the patients reduced PS Ag levels together with a normal free/total PS Ag ratio were seen. In the reperfusion phase no further reduction of total and free PS Ag could be observed.