Rejection diagnosisTrends in serum citrulline and acute rejection among recipients of small bowel transplants
Section snippets
Methods
Analysis of serum citrulline levels was carried out by ion-exchange chromatography with serum concentrations compared to biopsy-based grades of rejection. Histopathologic grading of endoscopic biopsies was used to diagnose rejection. Severity of rejection was graded from 0 (none) to 4 (severe) following the criteria of the Small Bowel Allograft Working Group.5 Patients were selected for statistical analysis based on their having at least two citrulline levels between postoperative days 30 to
Results
Out of our pool of 32 patients, 26 were found to have adequate data for our analysis. These patients underwent transplants between December 1998 and October 2001 and consisted of 12 pediatric patients and 14 adults having undergone 14 small bowel, 11 multivisceral, and one liver/small bowel transplants. In total, we have acquired 14 pretransplant samples taken within 24 hours before surgery, 15 control specimens from healthy volunteers, 194 posttransplant samples taken within 24 hours of
Conclusions
This analysis has demonstrated that decreasing or slowly increasing citrulline levels correlate with higher grades of rejection, while a patient achieving citrulline levels > 30 μmol/L in less than 90 days correlates with lower grades of acute cellular rejection after this period. As such, the rate and direction of change in serum citrulline levels over time can be a criterion for allograft health and risk of rejection. We find our results to date encouraging and we are vigorously pursuing
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Cited by (33)
Multivisceral Transplantation. Where Do We Stand?
2014, Clinics in Liver DiseaseCitation Excerpt :The use of noninvasive screening for rejection of the intestinal graft is in its infancy. Citrulline, calprotectin, perforin, and granzyme B have been used in monitoring for rejection; however, further studies are needed to confirm their applicability and prognostic importance.26,27 Histologic evaluation continues to be the gold standard for the diagnosis of rejection.
Which role in nutrition for the biologist apart from the evaluation of the nutritional status?
2014, Revue Francophone des LaboratoiresPlasma citrulline measurement using UPLC tandem mass-spectrometry to determine small intestinal enterocyte pathology
2009, Journal of Chromatography B: Analytical Technologies in the Biomedical and Life SciencesCitrulline as a biomarker of intestinal failure due to enterocyte mass reduction
2008, Clinical NutritionCitation Excerpt :From a practical point of view, the rapidity with which the result is obtained, which has to be the same day in all cases, is a crucial challenge. The duration of chromatography, including time of preanalytical preparation (centrifugation and deproteinization) must take no longer than 1 h. Also, citrulline has to be interpreted in the light of multiple interrelated parameters such as (a) time after surgery with progressive elevation of citrulline (1–3 months),88 (b) renal function (dehydration, drugs, etc., with higher citrullinemia than expected)65 and (c) graft pathology, for example, enteritidis80 and acute or chronic rejection whatever its cause80,89–92 with decline in citrullinemia. As shown in a pig model, the citrulline decline is only observed when diffuse severe mucosal damage has occurred, i.e. moderate and severe acute cellular rejection, but not in cases of indeterminate or mild acute cellular rejection.93
Intestinal transplantation
2007, Gastroenterologie Clinique et Biologique