Serum Immunoreactive Anodal Trypsinogen and Urinary Amylase as Biochemical Markers for Rejection of Clinical Whole-Organ Pancreas Allografts Having Exocrine Drainage Into the Urinary Bladder

Marks, William H.; Borgström, Anders; Sollinger, Hans W.; Marks, Christine

doi:10.1097/00007890-199001000-00025

Cited by 30 publications

(5 citation statements)

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“…506 In a study of five patients in whom rejection took place within 1 month after transplatation, concentrations of PLA 2 and of pancreatic trypsin inhibitor (PTI) in plasma were determined. The results indicated that plasma PLA 2 is a useful marker for allograft rejection, although the sensitivity was not as high as that of plasma PTI.…”

Section: A Exocrine Pancreasmentioning

confidence: 99%

Phospholipase A₂: Its Usefulness in Laboratory Diagnostics

Kaiser

1999

Critical Reviews in Clinical Laboratory Sciences

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Phospholipase A2 (PLA2) is an enzyme that catalyzes the hydrolysis of membrane phospholipids. This article reviews the source and structure of PLA2, the involvement of the enzyme in various biological and pathological phenomena, and the usefulness of PLA2 assays in laboratory diagnostics. Of particular importance is the role of PLA2 in the cellular production of mediators of inflammatory response to various stimuli. Assays for PLA2 activity and mass concentration are discussed, and the results of enzyme determinations in plasma from patients with different pathological conditions are presented. The determination of activity and mass concentration in plasma is particularly useful in the diagnosis and prognosis of pancreatitis, multiple organ failure, septic shock, and rheumatoid arthritis. A very important result is the demonstration that PLA2 is an acute phase protein, like CRP. Indeed, there is a close correlation between PLA2 mass concentration and CRP levels in several pathological conditions. Although the determination of C-reactive protein is much easier to perform and is routinely carried out in most clinical laboratories, the assessment of PLA2 activity or mass concentration has to be considered as a reliable approach to obtain a deeper understanding of some pathological conditions and may offer additional information concerning the prognosis of several disorders.

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Section: A Exocrine Pancreasmentioning

confidence: 99%

Phospholipase A₂: Its Usefulness in Laboratory Diagnostics

Kaiser

1999

Critical Reviews in Clinical Laboratory Sciences

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“…Benedetti and colleagues studied hypoamylasuria as a predictor of biopsy-proved pancreatic rejection and found its sensitivity to be 100% and specificity to be 30% [28]. Others have argued that the benefit of measuring urinary amylase is limited by large intra-and intersubject variability that might be related to hormonal influences on exocrine pancreatic function [29]. Although pancreatic histopathology is the gold standard for diagnosing rejection, pancreatic biopsies are not widely performed because of the perceived risk of complications such as [35].…”

Section: Discussionmentioning

confidence: 99%

Combined kidney-pancreas transplantation

Hricik

1998

Kidney International

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A 42-year-woman with a history of juvenile-onset diabetes mellitus was referred to University Hospitals of Cleveland for pancreas transplantation. Diabetes was first diagnosed at age 15, and insulin therapy was begun at that time. At the time of her referral, her serum creatinine concentration was 1.4 mg/dl and the creatinine clearance 80 ml/min. Protein excretion was 1.2 g/24 hrs. Diabetic retinopathy, discovered four years earlier, had been treated with laser surgery. A cadaveric pancreatic transplant was performed using pancreaticoduodenocystotomy. The patient's postoperative course was complicated by a peripancreatic abscess that required surgical drainage on two occasions. The patient was euglycemic and insulin-independent until one month following surgery, when overt hyperglycemia and a relative decrease in urinary amylase excretion prompted a 10-day course of treatment with OKT3 for presumed acute allograft rejection. Her blood sugar level returned to the normal range; five months later, however, a second rejection episode did not respond to treatment with OKT3. The patient's pancreatic allograft was surgically removed and insulin therapy was renewed.During the subsequent 18 months, the patient developed peripheral vascular disease requiring a right transmetatarsal amputation; this was followed by a right, below-the-knee amputation. During this interval, the patient's renal function gradually deteriorated, in part because of two episodes of contrast-medium-induced nephropathy following aortography. She developed end-stage renal disease requiring initiation of maintenance hemodialysis.Two years following the initial pancreatic transplant, the patient received simultaneous kidney and pancreas transplants from one cadaveric donor. Maintenance immunosuppression consisted of cyclosporine, pred-nisone, and azathioprine. One month following transplantation, the patient was treated with OKT3 for acute renal allograft rejection. Thereafter, she maintained excellent renal allograft function. Glycohemoglobin levels, which had ranged between 8.5% and 9.3% during the six months prior to transplantation, decreased to 4.3% within two months of transplantation. Visual acuity measured within two months after the transplant procedure was 20/300 OD and 20/200 OS.In the seven years following combined kidney-pancreas transplantation, the patient was readmitted to the hospital on 12 occasions. Three separate hospital admissions were prompted by gross hematuria. Cystoscopic evaluation revealed only acute and chronic inflammation of the bladder mucosa and duodenal cuff. Recurrent hematuria prompted enteric conversion of the pancreatic allograft via a pancreaticojejunostomy approximately six years following transplanation. Two years later, the patient developed gangrene of the left foot, which required a left Syme's amputation. Five years following kidney-pancreas transplantation, the patient published an autobiography detailing how the transplant had improved her quality of life. At last followup, her serum creatinine concentrati...

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“…High serum amylase levels ( > 600 U/l), however, were nearly always associated with an interstitial infiltrate and might, therefore, still be clinically useful. Some promising results have been found in studies regarding the use of serum anodal trypsinogen as a putative marker for pancreas rejection [5, 12,201. Further studies, correlating serum anodal trypsinogen with pancreas core biopsy-proven rejection, are needed to determine whether it may be a useful rejection marker.…”

Section: Discussionmentioning

confidence: 99%

“…Serum amylase and pancreas-specific protein have been shown to be sensitive, but not specific, markers for rejection [ S , 13,291. Hypoamylasuria may be used as a marker in bladder-drained transplants as it correlates with histologically defined pancreas rejection; however, major differences in specificity have been reported [2,12,14,181. Serum anodal trypsinogen has been reported to be a reliable, graftspecific rejection marker [5, 12,201.…”

Section: Introductionmentioning

confidence: 99%

Interstitial and vascular pancreas rejection in relation to graft survival

Boonstra¹,

Pijl²,

Es³

et al. 1997

Transplant Int

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Interstitial and vascular pancreas rejection in relation to graft survivalAbstract To examine the incidence Key words Pancreas of interstitial and vascular rejection in pancreas allografts and its impact on graft survival, we studied 36 percutaneous pancreas biopsies and 10 pancreas transplantectomy specimens from 32 patients who had undergone simultaneous pancreas-kidney transplantation. Interstitial rejection (IR) was predominantly found in the biopsies, while vascular rejection (VR) was most prominent in the transplantectomies. Pancreas graft survival was significantly decreased for pancreas grafts that had suffered from vascular rejection when compared to those with only interstitial rejection. Potential rejection markers, i. e., serum amylase, glucose, creatinine, and urinary amylase, did not correlate with histological signs of rejection, although increased levels of serum amylase were, in all but one case, associated with rejection.We conclude that a percutaneous pancreas biopsy remains the most reliable method to determine pancreas rejection, and that by distinguishing between IR and VR, a pancreas biopsy may provide important diagnostic as well as prognostic information.

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Serum Immunoreactive Anodal Trypsinogen and Urinary Amylase as Biochemical Markers for Rejection of Clinical Whole-Organ Pancreas Allografts Having Exocrine Drainage Into the Urinary Bladder

Cited by 30 publications

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Phospholipase A₂: Its Usefulness in Laboratory Diagnostics

Phospholipase A₂: Its Usefulness in Laboratory Diagnostics

Combined kidney-pancreas transplantation

Interstitial and vascular pancreas rejection in relation to graft survival

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Serum Immunoreactive Anodal Trypsinogen and Urinary Amylase as Biochemical Markers for Rejection of Clinical Whole-Organ Pancreas Allografts Having Exocrine Drainage Into the Urinary Bladder

Cited by 30 publications

References 0 publications

Phospholipase A2: Its Usefulness in Laboratory Diagnostics

Phospholipase A2: Its Usefulness in Laboratory Diagnostics

Combined kidney-pancreas transplantation

Interstitial and vascular pancreas rejection in relation to graft survival

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Product

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Phospholipase A₂: Its Usefulness in Laboratory Diagnostics

Phospholipase A₂: Its Usefulness in Laboratory Diagnostics