The importance of lipase determinations in the detection of pancreaticoduodenal allograft rejection.

In canine pancreaticoduodenal allografts, the exocrine pancreas is rejected earlier that endocrine islets. Lipase levels prove to be a good parameter of the rejection onset, occurring before other parameters showed any changes. Moreover there is a good correlation between the lipasemia and the functional condition of the exocrine pancreas in periods before and after the rejection crisis. Variations in other parameters which occur during rejection and consequently can sustain the diagnosis of rejection, are an amylase rise, a leucocytosis, a fasting insulin decrease and glucose increase. These changes however are less striking than lipase variations; besides they do not occur constantly and can also be seen in other circumstances. In this way they not only lack rejection specificity but likewise do not allow the functional evolution during and after the rejection crisis. The insulinemia, after glucose loading, is the only one of the mentioned parameters which gives an adequate idea of the endocrine graft function and which consequently has a prognostic value after the rejection crisis, with regard to the function and the survival of the graft. Cool storage preservation of the grafts using a Largiadèr solution proved to have no detrimental effects on the pancreas, as judged by the graft function, the postoperative survival time of the dogs and the rejection pattern of the transplants.