Loris Pironi1, Mariacristina Guidetti1, Augusto Lauro2, Chiara Zanfi2, Federica Agostini1,3, Antonietta D'Errico4, Annalisa Altimari4, Antonio D Pinna2. 1. Center for Chronic Intestinal Failure, Department of Gastroenterology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 2. Transplantation Surgical Unit, Department of Organ Failure and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 3. PhD on Medical Sciences, University of Bologna, Bologna, Italy. 4. Center for Histopathological and Molecular Diagnostic of Solid Organ Transplantation, Department of Organ Failure and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Abstract
BACKGROUND: Plasma citrulline concentration (CIT) depends on its synthesis by enterocytes and its catabolism by renal tubules. To evaluate CIT applicability as a marker of acute cellular rejection (ACR) after intestinal transplantation (ITx), CIT was investigated according to time from ITx, episodes of ACR, and creatinine clearance (CrCl). METHODS: Twenty-four adult ITx recipients were prospectively studied. The results were compared with those of 19 healthy controls (HCs) and of 29 patients with chronic renal failure (CRF). RESULTS: In ITx recipients, CIT was lower than in HCs during the first two postoperative weeks; it then progressively increased and reached the range observed in HCs, approximately between the 31st and the 45th postoperative day. A positive association with postoperative days (R = 0.63; p < 0.0001) and a negative association with CrCl (R = -0.57; p < 0.0001) were observed. CIT was higher in patients with CRF than in HCs (p < 0.0001). CIT sensitivity and specificity in detecting ACR after the 45th postoperative day were 38% and 83%, using CIT threshold observed in HCs, and 69% and 77%, respectively, using CIT threshold adjusted for CRF degree. CONCLUSIONS: Adjusting CIT threshold for CRF degree almost doubled the sensitivity of CIT as a non-invasive marker of ACR in ITx recipients.
BACKGROUND: Plasma citrulline concentration (CIT) depends on its synthesis by enterocytes and its catabolism by renal tubules. To evaluate CIT applicability as a marker of acute cellular rejection (ACR) after intestinal transplantation (ITx), CIT was investigated according to time from ITx, episodes of ACR, and creatinine clearance (CrCl). METHODS: Twenty-four adult ITx recipients were prospectively studied. The results were compared with those of 19 healthy controls (HCs) and of 29 patients with chronic renal failure (CRF). RESULTS: In ITx recipients, CIT was lower than in HCs during the first two postoperative weeks; it then progressively increased and reached the range observed in HCs, approximately between the 31st and the 45th postoperative day. A positive association with postoperative days (R = 0.63; p < 0.0001) and a negative association with CrCl (R = -0.57; p < 0.0001) were observed. CIT was higher in patients with CRF than in HCs (p < 0.0001). CIT sensitivity and specificity in detecting ACR after the 45th postoperative day were 38% and 83%, using CIT threshold observed in HCs, and 69% and 77%, respectively, using CIT threshold adjusted for CRF degree. CONCLUSIONS: Adjusting CIT threshold for CRF degree almost doubled the sensitivity of CIT as a non-invasive marker of ACR in ITx recipients.
Authors: Pablo Stringa; David Romanin; Natalia Lausada; Rodrigo Papa Gobbi; Carolina Zanuzzi; Pedro Martín; Juan Cruz Abate; Ana Cabanne; Nathalie Arnal; Leandro Vecchio; Verónica Milesi; Enrique Portiansky; Gabriel Gondolesi; Martin Rumbo Journal: Transplant Direct Date: 2017-10-06