Prieto M, Sutherland D E, Fernandez-Cruz L, Heil J, Najarian J S
Transplantation. 1987 Jan;43(1):73-9. doi: 10.1097/00007890-198701000-00017.
Pancreas allograft rejection in dogs with pancreaticocystostomy can be predicted in advance of hyperglycemia by monitoring the urinary amylase (UA) concentration (U/L): In initial experiments, UA values declined to less than 1000 1.3 +/- 0.2 days before hyperglycemia in nonimmunosuppressed dogs, 3.3 +/- 1.0 days in dogs treated with cyclosporine (CsA), and 9.3 +/- 0.7 days in dogs treated with CsA, azathioprine (Aza), and prednisone (triple therapy). Autotransplanted control dogs maintained high urine amylase concentrations indefinitely (mean 125,544 +/- 36,931). In a subsequent experiment, in 19 dogs with bladder-drained pancreas allografts on CsA only for prophylactic immunosuppression, a five-day course of antirejection treatment with Aza (5.0 mg/kg) and antilymphocyte globulin ALG (1 mg/kg) was started in group A (n = 10) when a raise in serum glucose was detected, and in group B (n = 9) when a drop of UA below 1000 was observed. The functional allograft survival rate was 9.2 +/- 0.5 days in group A (treatment started after hyperglycemia) and 29.0 +/- 5.7 days in group B (treatment started after drop in UA) (P = .002). The UA dropped in all dogs before hyperglycemia, at a mean of 2.7 days in group A and 20.8 days in group B. Clinically, 8 patients received a whole cadaver pancreas transplant with urinary drainage of the exocrine secretions. All were followed with UA monitoring. Three recipients lost the grafts for technical reasons. Three recipients lost the grafts for technical reasons. One had a primary non-function and UA was below 1000 U/24 hr; two developed abscesses and the grafts were removed while functioning with high UA values. Five grafts are currently functioning; 3 recipients had no rejection episodes and their UA values ranged from 30,000 to 100,000 U/24 hr during their entire postoperative course. The other two had rejection episodes. In both cases UA decreased to baseline levels 1 and 4 days in advance of the hyperglycemia. After antirejection treatment UA rose again to high values and plasma glucose levels declined. Both patients are currently insulin-independent, with UA values ranging from 10,000 to 200,000 U/24 hr. Both experimentally and clinically UA is an early predictor of pancreas allograft rejection. The institution of early treatment of rejection episodes in dogs, based on UA, significantly improved allograft survival. Urine amylase monitoring in pancreas transplant recipients could lead to an early treatment of rejection and improve graft survival.
对于行胰囊肿造口术的犬类胰腺移植，可通过监测尿淀粉酶（UA）浓度（单位：U/L）在高血糖出现之前预测移植排斥反应：在最初的实验中，非免疫抑制犬的UA值在高血糖出现前1.3±0.2天降至1000以下；接受环孢素（CsA）治疗的犬为3.3±1.0天；接受CsA、硫唑嘌呤（Aza）和泼尼松（三联疗法）治疗的犬为9.3±0.7天。自体移植的对照犬尿淀粉酶浓度持续维持在较高水平（平均125,544±36,931）。在随后的一项实验中，19只仅接受CsA预防性免疫抑制、膀胱引流式胰腺移植的犬，当检测到血清葡萄糖升高时，A组（n = 10）开始为期5天的Aza（5.0 mg/kg）和抗淋巴细胞球蛋白ALG（1 mg/kg）抗排斥治疗；当观察到UA降至1000以下时，B组（n = 9）开始治疗。A组（高血糖出现后开始治疗）功能性移植存活率为9.2±0.5天，B组（UA下降后开始治疗）为29.0±5.7天（P = 0.002）。所有犬在高血糖出现前UA均下降，A组平均为2.7天，B组为20.8天。临床上，8例患者接受了全尸体胰腺移植，外分泌液经尿液引流。均通过监测UA进行随访。3例受者因技术原因失去移植物。1例出现原发性无功能，UA低于1000 U/24小时；2例发生脓肿，在移植物功能良好且UA值高时将其切除。5个移植物目前功能良好；3例受者未发生排斥反应，术后全程UA值在30,000至100,000 U/24小时之间。另外2例发生了排斥反应。在这两例中，UA在高血糖出现前1天和4天降至基线水平。抗排斥治疗后，UA再次升至较高值，血糖水平下降。两名患者目前均无需使用胰岛素，UA值在10,000至200,000 U/24小时之间。无论是在实验还是临床中，UA都是胰腺移植排斥反应的早期预测指标。基于UA对犬类排斥反应进行早期治疗，显著提高了移植物存活率。对胰腺移植受者进行尿淀粉酶监测可实现排斥反应的早期治疗并提高移植物存活率。
