Immunoreactive trypsinogen levels in pediatric patients with intestinal failure awaiting intestinal transplantation

Abstract

The aim of this study was to evaluate pancreatic function in total parenteral nutrition (TPN)-dependent children with permanent intestinal failure by measuring immunoreactive trypsinogen (IRT) levels. Between 1992 and 1996, 105 pediatric patients with permanent intestinal failure were referred to the Children's Hospital of Pittsburgh for small intestinal transplant evaluation. Serum samples were available from 55 of them. Ten suffered from intestinal pseudo-obstruction or microvillus inclusion disease, while 45 had short bowel syndrome (SBS). IRT levels were significantly higher (p < 0.001) in SBS patients (89.4 +/- 9.2 ng mL) compared to controls (43.4 +/- 5.6 ng/ nL) without liver, gastrointestinal, or kidney disease. IRT levels did not correlate with liver injury, length of bowel, or the cause of SBS. Five of 20 patients who underwent intestinal transplantation developed pancreatitis during a median post-operative follow up 15.4 months later. IRT levels failed to predict who would develop pancreatitis post-transplant. The data suggest that elevated plasma IRT levels are common among children with intestinal failure, but fail to identify patients at risk for pancreatitis post-transplant.

Nutrition support considerations in pediatric small bowel transplantation

“…The prevalence of pancreatitis during the early years of pediatric ITx was reported to be up to 25%. 39 More recently, Borhani et al reported a lower rate of acute and chronic pancreatitis (>6% and <1%, respectively) in adults post-ITx. 40 Enteral or oral pancreatic enzyme replacement therapy (PERT) may be required to improve absorption of enteral/oral macronutrients during episodes of pancreatitis post-ITx or when concerns for exocrine pancreatic insufficiency exist.…”

“…In these situations, IV fluids or PN may need to be resumed temporarily for fluid balance and nutrition when enteral/oral intake is insufficient. The prevalence of pancreatitis during the early years of pediatric ITx was reported to be up to 25% 39 . More recently, Borhani et al reported a lower rate of acute and chronic pancreatitis (>6% and <1%, respectively) in adults post‐ITx 40 .…”

Pancreatitis in Solid Organ Transplant Patients: A Review of the Literature

“…Acute pancreatitis is the most common pancreaticobiliary complication after intestinal transplantation, including small or large bowel transplant and multivisceral transplant. It occurs in approximately 6% of the adult intestinal transplant population [49,50] and in up to 25% of the pediatric intestinal transplant population [51]. Notably, pancreatitis may be seen in the graft and/or the native pancreas [49].…”