Serum pancreatic secretory trypsin inhibitor (PSTI) level predicts early stage of pancreas allograft rejection.
Serum Pancreatic Secretory Trypsin Inhibitor (PSTI) as a marker of rejection was examined in the course of canine pancreatic transplantation. In the case of allotransplantation without immunosuppression, serum PSTI showed two significant elevations: The first elevation on the first day after transplantation was related to operative procedures and the second elevation on the sixth or seventh day reflected early stage of rejection, because the first elevation was observed after both autotransplantation and allotransplantation and biopsies of pancreas grafts showed nonspecific neutrophilic infiltration on the first day and typical interstitial lymphoid infiltrates with cellular rejection of the exocrine tissue on the seventh day. In contrast, in the case of allotransplantation with immunosuppression (cyclosporine and prednisolone), serum PSTI showed only the first elevation due to the operative procedures. Biopsies of the pancreas allografts showed nonspecific neutrophilic infiltration until the third day and no interstitial lymphoid infiltrates on the seventh day. In addition, when the salvage immunosuppression was started at the beginning of the second PSTI elevation (on the seventh day), serum PSTI level was clearly declined and there were survivals of the grafts to over two weeks in six of eight dogs. Biopsies of the pancreas grafts taken on the seventh day after starting the salvage immunosuppression showed almost normal pancreatic architecture except moderate fibrosis in the exocrine tissue. The results show that serum PSTI can detect early stage of pancreas graft rejection so that the salvage immunosuppression can be implemented effectively.
Department of Surgery, Kobe University School of Medicine.
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Suzuki
D000681:Amylases / Q000097:blood; D000818:Animals; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D004285:Dogs; D006084:Graft Rejection / Q000187:drug effects / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007167:Immunotherapy; D016035:Pancreas Transplantation / Q000276:immunology*; D014359:Trypsin Inhibitor, Kazal Pancreatic / Q000097:blood
D015415:Biomarkers; D001786:Blood Glucose; D014359:Trypsin Inhibitor, Kazal Pancreatic; D000681:Amylases