Experimental and clinical experience with urine amylase monitoring for early diagnosis of rejection in pancreas transplantation

Mikel Prieto, David E R Sutherland, Laureano Fernandez-Cruz, John Heil, John S. Najarian

Research output: Contribution to journalArticle

115 Scopus citations

Abstract

Pancreas allograft rejection in dogs with pancreati-cocystostomy can be predicted in advance of hyperglycemia by monitoring the urinary amylase (UA) concentration (U/L): In initial experiments, UA values declined to <1000 1.3±0.2 days before hyperglycemia in non-immunosuppressed 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. One had a primary nonfunction 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 in.

Original languageEnglish (US)
Pages (from-to)73-78
Number of pages6
JournalTransplantation
Volume43
Issue number1
StatePublished - 1987
Externally publishedYes

    Fingerprint

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Prieto, M., Sutherland, D. E. R., Fernandez-Cruz, L., Heil, J., & Najarian, J. S. (1987). Experimental and clinical experience with urine amylase monitoring for early diagnosis of rejection in pancreas transplantation. Transplantation, 43(1), 73-78.