Perkins J D, Munn S R, Barr D, Ferguson D C, Carpenter H A
Section of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Transplantation. 1990 Feb;49(2):363-6. doi: 10.1097/00007890-199002000-00027.
In 18 consecutive pancreaticoduodenal allograft recipients (15 combined kidney/pancreas and 3 pancreas only after a prior successful kidney transplantation) operated on between December 1987 and February 1989, we studied the soluble interleukin 2 receptor (SIL-2R) level over time. All pancreaticoduodenal allografts were transplanted with exocrine drainage via a duodenocystostomy that allowed for cystoscopically directed needle biopsies of the pancreas. Of these 18 recipients, at 6 weeks after transplantation, 6 had had no rejection episodes or cytomegalovirus disease (control group), an acute allograft rejection had developed in 7, CMV disease developed in 4, and both rejection and CMV disease developed in 1 by 12 days after transplantation. SIL-2R level increased in all patients during immunosuppressive induction therapy (preoperative mean +/- SE, 1637 +/- 284 U/mL; maximum, 4367 +/- 687 U/mL). After induction therapy, the mean was 2768 +/- 432 U/mL. In all 6 recipients in the control group, SIL-2R level continued to decrease. However, SIL-2R level was significantly higher compared with controls, in those who had CMV disease (levels were increased at a mean of 7 days before diagnosis of CMV disease) and in those who had acute rejection episodes (levels were increased a mean of 7 days before the clinical diagnosis of rejection). Factors that did not cause an increase in SIL-2R level included acute pancreatitis, wound infection, operative procedures, and CsA nephrotoxicity. SIL-2R level can be useful for monitoring pancreaticoduodenal allograft recipients. Increases predict impending rejection or CMV disease, prior to the onset of organ dysfunction. When SIL-2R level increases, we recommend cultures of blood and urine to exclude CMV and pancreaticoduodenal allograft biopsy to confirm early rejection prior to the initiation of potentially dangerous antirejection therapy.
在1987年12月至1989年2月期间接受手术的18例连续性胰十二指肠移植受者（15例为肾/胰腺联合移植，3例为在先前肾移植成功后仅行胰腺移植）中，我们对可溶性白细胞介素2受体（SIL-2R）水平随时间的变化进行了研究。所有胰十二指肠移植均通过十二指肠膀胱吻合术进行外分泌引流，该术式允许通过膀胱镜对胰腺进行穿刺活检。在这18例受者中，移植后6周时，6例未发生排斥反应或巨细胞病毒病（对照组），7例发生了急性移植排斥反应，4例发生了巨细胞病毒病，1例在移植后12天内既发生了排斥反应又发生了巨细胞病毒病。在免疫抑制诱导治疗期间，所有患者的SIL-2R水平均升高（术前平均值±标准误，1637±284 U/mL；最高值，4367±687 U/mL）。诱导治疗后，平均值为2768±432 U/mL。在对照组的所有6例受者中，SIL-2R水平持续下降。然而，与对照组相比，发生巨细胞病毒病的患者（在巨细胞病毒病诊断前平均7天水平升高）和发生急性排斥反应的患者（在排斥反应临床诊断前平均7天水平升高）的SIL-2R水平显著更高。未导致SIL-2R水平升高的因素包括急性胰腺炎、伤口感染、手术操作和环孢素肾毒性。SIL-2R水平可用于监测胰十二指肠移植受者。其升高预示着在器官功能障碍发生之前即将发生排斥反应或巨细胞病毒病。当SIL-2R水平升高时，我们建议进行血液和尿液培养以排除巨细胞病毒，并进行胰十二指肠移植活检以在启动潜在危险的抗排斥治疗之前确认早期排斥反应。
