Ekberg H, Allen R D, Greenberg M L, Stewart G J, Deane S A, Little J M
Department of Surgery, Sydney University, Australia.
Diabetes. 1989 Jan;38 Suppl 1:109-10. doi: 10.2337/diab.38.1.s109.
Early diagnosis of rejection in pancreas-allograft transplantation remains a clinical challenge. The aim of this study was to assess the ability of antirejection therapy to reverse rejection when the diagnosis was based on either fine-needle aspiration biopsy (FNAB) or urinary amylase (UA). Sixteen dogs received a total-pancreas allograft with exocrine drainage into the bladder. Initially, a deliberately low dose of cyclosporin was given. Monitoring included percutaneous FNAB with ultrasound guidance and fasting spot measurements of UA. The diagnosis of rejection was made in alternate dogs when UA fell to less than 5000 IU/L (group A) or when the total corrected increment (TCI) of aspirated infiltrating cells was greater than 2.6 (group B). Antirejection therapy consisted of 10 mg.kg-1.day-1 i.v. methylprednisolone for 5 days and an increased dose of cyclosporin (25 mg.kg-1.day-1). The median allograft survival was 9 days (range 8-19) in group A and 32 days (range 10-63) in group B (P = .01). A fall in UA permitted the successful reversal of rejection in only one of six grafts, whereas five of seven grafts were successfully treated when rejection diagnosis was based on FNAB. In conclusion, early diagnosis of rejection was achieved by FNAB, improving the ability of antirejection therapy to reverse pancreas-allograft rejection and prolong survival.
胰腺移植排斥反应的早期诊断仍是一项临床挑战。本研究旨在评估当诊断基于细针穿刺活检（FNAB）或尿淀粉酶（UA）时，抗排斥治疗逆转排斥反应的能力。16只犬接受了全胰腺移植，外分泌液引流至膀胱。最初，给予低剂量的环孢素。监测包括超声引导下的经皮FNAB和空腹晨尿UA测定。当UA降至低于5000 IU/L（A组）或吸出浸润细胞的总校正增量（TCI）大于2.6（B组）时，对交替分组的犬进行排斥反应诊断。抗排斥治疗包括静脉注射甲泼尼龙10 mg·kg-1·d-1，持续5天，并增加环孢素剂量（25 mg·kg-1·d-1）。A组移植胰腺的中位存活时间为9天（范围8 - 19天），B组为32天（范围10 - 63天）（P = 0.01）。UA下降仅使6个移植物中的1个成功逆转排斥反应，而当基于FNAB诊断排斥反应时，7个移植物中有5个成功得到治疗。总之，FNAB实现了排斥反应的早期诊断，提高了抗排斥治疗逆转胰腺移植排斥反应和延长存活时间的能力。
