The Significance of Urine Amylase in the Early Diagnosis of Allograft Rejection after Pancreas Transplantation.
- Author:
Hyuk Jai JANG
1
;
Song Cheal KIM
;
Duck Jong HAN
Author Information
1. Department of General Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Pancreas transplantation;
Urine amylase;
Rejection
- MeSH:
Allografts*;
Amylases*;
Diagnosis;
Drainage;
Early Diagnosis*;
Graft Survival;
Humans;
Immunosuppressive Agents;
Insulin;
Pancreas Transplantation*;
Pancreas*;
Retrospective Studies;
Transplants;
Urinary Bladder
- From:The Journal of the Korean Society for Transplantation
1998;12(2):285-296
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Pancreas transplantation has became an accepted form of therapy for insulin dependent DM (IDDM). However, rejection remains the major cause of graft loss in pancreas allografts. To overcome the immunologic graft loss following pancreas allograft, early reliable method for rejection is crucial. The purpose of this study was to evaluate the significance of urine amylase (UA) levels as a reliable and sensitive indicator of pancreas allograft rejection retrospectively. Over a 15-month study period from August '97 to Cotover '98, 9 pancreas transplants with bladder drainage were performed at our center. Among which 6 pancreas transplantation alone (PTA) and 3 simultaneous pancreas-kidney transplantation (SPK) were performed. The diagnosis of rejection was based on clinical criteria (fever, tenderness, leukocytosis) and serology such as, a reduction in UA level. Rejection was developed in 5 patients (56%), including 4 PTA and 1 SPK recipients. Mean UA level during normal allograft function was 89,365 U/L, whereas level heralding rejection was 14,760 U/L (P<0.05). After steroid pulse therapy, first rejection episode result in 100% reversal of rejection and the UA level returned toward normal (mean 95,437 U/L). However more than one rejection episode resulted in poor outcome (all the graft were lost). Overall, reversal of rejection occurred in 63% of cases, with 2 PTA and 1 SPK lost due to rejection. Monitoring pancreas-allograft function by UA allows for the timely diagnosis and successful treatment of pancreas-allograft rejection. For more than one rejection episodes, more potent immunosuppressants are through needed to be improve the graft survival.
