Perkal M, Marks C, Lorber M I, Marks W H
Division of Transplantation and Immunology, Yale University School of Medicine, New Haven, Connecticut 06510.
Transplantation. 1992 Feb;53(2):415-9. doi: 10.1097/00007890-199202010-00028.
Serum values of immunoreactive anodal trypsinogen (sAT) have been claimed to correlate well with rejection occurring in pancreatic allografts. We have studied the behavior of sAT in serial serum samples obtained from 39 type I diabetics undergoing whole-organ pancreas transplantation during the past 3 years. Patients had either received a pancreatic allograft simultaneously with a transplanted kidney (SPK, n = 33) or after a previous kidney transplant (pancreas after kidney [PAK] n = 6). The behavior of sAT was studied in relation to the clinical diagnosis of rejection. Graft amylase output for all 39 patients and serum creatinine for the 33 SPK recipients were also studied. Tissue biopsies were obtained from 11 patients with elevated sAT values and a presumptive diagnosis of rejection. Nine of these patients had SPK grafts and simultaneously elevated creatinine values. Tissue was obtained from the simultaneously transplanted kidney; all specimens revealed rejection. Two of the 11 patients had PAK allografts. Biopsies performed on the graft duodenum were consistent with acute rejection. Three additional patients with unchanged sAT values had biopsies for other reasons; these biopsies failed to demonstrate signs of acute rejection. Thus graft biopsy correlated exactly with sAT behavior in every case in which rejection was suspected. Five patients had elevations of sAT not associated with rejection: one resulted from direct trauma, two had outlet obstruction, and two had clinical diagnoses of graft pancreatitis. The sAT was more sensitive and specific than GAO and as sensitive as creatinine for SPK recipients. These studies confirm that sAT is a reliable, graft-specific biochemical marker for the early diagnosis of pancreatic rejection. The use of sAT should allow for the proper timing of graft biopsies and the judicious use of immunosuppressive agents, which will result in increased allograft survival for PAK and pancreas-alone allografts.
免疫反应性阳极胰蛋白酶原（sAT）的血清值据称与胰腺同种异体移植中发生的排斥反应密切相关。我们研究了在过去3年中接受全器官胰腺移植的39例I型糖尿病患者的系列血清样本中sAT的变化情况。患者要么同时接受了胰腺同种异体移植和肾脏移植（SPK，n = 33），要么在先前肾脏移植后接受了胰腺移植（肾后胰腺移植[PAK]，n = 6）。研究了sAT的变化与排斥反应临床诊断之间的关系。还研究了所有39例患者的移植胰腺淀粉酶分泌量以及33例SPK受者的血清肌酐水平。对11例sAT值升高且初步诊断为排斥反应的患者进行了组织活检。其中9例患者接受了SPK移植，同时肌酐值升高。从同时移植的肾脏获取组织；所有标本均显示排斥反应。11例患者中有2例接受了PAK移植。对移植胰腺十二指肠进行的活检与急性排斥反应一致。另外3例sAT值未变化的患者因其他原因进行了活检；这些活检未显示急性排斥反应的迹象。因此，在每例疑似排斥反应的病例中，移植活检结果与sAT变化情况完全相符。5例患者的sAT升高与排斥反应无关：1例是直接创伤所致，2例是出口梗阻，2例临床诊断为移植胰腺炎。对于SPK受者，sAT比胰淀粉酶输出量（GAO）更敏感、更具特异性，与肌酐敏感性相当。这些研究证实，sAT是用于胰腺排斥反应早期诊断的可靠的、移植器官特异性生化标志物。使用sAT应能确定进行移植活检的合适时机，并明智地使用免疫抑制剂，这将提高PAK移植和单纯胰腺移植的同种异体移植物存活率。
