Brattström C, Tydén G, Reinholt F P, Bohman S O, Borgström A, Bäckman L, Bolinder J, Groth C G
Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden.
Diabetes. 1989 Jan;38 Suppl 1:57-62. doi: 10.2337/diab.38.1.s57.
Rejection episodes were studied in 15 patients, in whom no kidney graft could serve as a marker for rejection, subjected to pancreas transplantation with pancreatoenterostomy and temporary exteriorization of the pancreatic juice (10 pancreas alone, 3 pancreas after kidney, and 2 combined pancreas and kidney in which the kidney was not functioning.) Twelve patients (80%) had a total of 18 rejection episodes. In the first 11 patients, 13 rejection episodes were diagnosed by a decline in amylase activity in the pancreatic juice, whereas in the next 4 patients, 5 rejection episodes were diagnosed by positive cytology in the pancreatic juice. Neopterin in pancreatic juice and immunoreactive anionic trypsin in serum showed promise as rejection markers, whereas serum neopterin, serum amylase, and serum immunoreactive cationic trypsin did not. Unspecific signs of rejections were an increase in white blood cell count, clinical symptoms such as fever, abdominal pain, and arthralgia. All acute rejection episodes were successfully reversed by antirejection treatment. However, late rejections diagnosed by impaired endocrine function were seen in 6 of the 15 (40%) patients, and the prognoses for these rejections were worse: 4 patients (27%) lost their grafts because of chronic rejections, and 2 patients still had impaired endocrine function.
对15例患者的排斥反应进行了研究，这些患者没有可作为排斥反应标志物的肾移植，接受了胰肠吻合术和胰液临时外置的胰腺移植（10例单纯胰腺移植，3例肾移植后胰腺移植，2例胰肾联合移植且肾无功能）。12例患者（80%）共发生18次排斥反应。在前11例患者中，13次排斥反应通过胰液淀粉酶活性下降诊断，而在后4例患者中，5次排斥反应通过胰液细胞学阳性诊断。胰液中的新蝶呤和血清中的免疫反应性阴离子胰蛋白酶有望作为排斥反应标志物，而血清新蝶呤、血清淀粉酶和血清免疫反应性阳离子胰蛋白酶则不然。排斥反应的非特异性体征为白细胞计数增加、发热、腹痛和关节痛等临床症状。所有急性排斥反应均通过抗排斥治疗成功逆转。然而，15例患者中有6例（40%）出现了由内分泌功能受损诊断的晚期排斥反应，这些排斥反应的预后较差：4例患者（27%）因慢性排斥反应失去了移植物，2例患者仍有内分泌功能受损。
