Pancreatic elastase 1 after pancreatic transplantation.

Human pancreatic elastase 1 (E1) is a novel pancreas-specific proteinase that has not yet been investigated after pancreatic transplantation (PTx). Using a recently developed E1 ELISA, we studied the E1 serum curves in 36 type I diabetic patients subjected to PTx with enteric exocrine diversion from the pretransplant value up to 8 years after transplantation (n = 731 samples). A characteristical pattern was observed: following PTx, E1 rose above the normal range to a peak within 6 days and then gradually fell to stabilize after 4-6 weeks at an elevated level (10 ng/ml) for approximately 1 year. Two to 8 years after PTx, E1 levels were still slightly elevated (1-6 ng/ml) in 14/20 patients. During 24 acute rejection episodes, E1 was found not be a sensitive rejection marker during the early postoperative period because of its slow decline from the peak level. However, increasing E1 levels in seven patients more than 2 months after PTx were associated with a variety of lesions to the pancreatic graft, thus suggesting a useful marker indicating exocrine graft damage late after PTx. The slightly elevated levels even years after PTx are most probably due to the non-portal venous drainage of the pancreatic graft.