title: Role and significance of plasma citrulline in the early phase after small bowel transplantation in pigs.
abstract: A reliable serological marker of acute cellular rejection (ACR) after small bowel transplantation (SBTx) is still missing. Plasma citrulline level (PCL) reflects the functional integrity of intestinal mucosa which is partially lost during ACR. The aim of our study was to investigate the role of PCL as marker of ACR after SBTx. Eighteen German landrace pigs were used and divided into three groups. Group 1 (G1), autologous SBTx (n = 4) as control; group 2 (G2), allogeneic SBTx without immunosuppression (IS) (n = 7) and group 3 (G3), allogeneic SBTx with IS (n = 7). IS consisted of tacrolimus and steroids without induction treatment. Observation period was 14 days. Mucosal biopsies were obtained intraoperatively and daily using a Thiry-Vella loop. ACR was differentiated into indeterminate, mild, moderate and severe using a standardized grading schema. PCL was measured daily. An ACR onset occurred generally from postoperative day 4 both in G2 and G3 as mild form and developed differently in the two groups: moderate to severe in G2 and indeterminate to mild in G3. A significant decline of PCL occurred only in cases of moderate and severe ACR, but not in cases of indeterminate and mild ACR. The PCL failed as a marker in the early diagnosis of ACR and became reliable only when advanced mucosal damage was present.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany. silvio.nadalin@uni-due.de
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Biglarnia
authors.forename: Giuliano
authors.initials: G
authors.lastname: Testa
authors.forename: Tobias R
authors.initials: TR
authors.lastname: Koppara
authors.forename: Randolph
authors.initials: R
authors.lastname: Schaffer
authors.forename: Cecilia
authors.initials: C
authors.lastname: Johnson
authors.forename: Martin
authors.initials: M
authors.lastname: Toetsch
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D002956:Citrulline / Q000097:blood*; D005260:Female; D006084:Graft Rejection / Q000097:blood*; D007421:Intestine, Small / Q000473:pathology / Q000637:transplantation*; D016377:Organ Transplantation / Q000009:adverse effects / Q000473:pathology; D015427:Reperfusion Injury / Q000473:pathology; D013552:Swine
chemical_list: D015415:Biomarkers; D002956:Citrulline