title: Selenium homocholic acid taurocholate scanning, selenium-75-labeled bile acid, a novel method for testing the function of the terminal ileum in small bowel transplant recipients: a pilot study.
abstract: BACKGROUND
  The terminal ileum (TI) is important for the active reabsorption of bile salts and is the site of allograft rejection; disruption of enterohepatic circulation (EHC) may give insights to inflammatory and other physiologic processes at the TI.
  
  
  METHODS
  Four children aged 5 to 12 years who had received small bowel transplantation (SBTx), 3 recovering from post-transplant lymphoproliferative disease (PTLD) and 1 with acute rejection, were studied. Two of the 4 had stoma reversal. Another child (15 years) with progressive familial intrahepatic cholestasis (PFIC) and pruritus, despite liver transplantation and biliary diversion, was studied. Selenium homocholic acid taurocholate scanning ((75)SeHCAT) capsule was given orally (n = 3) or via introducer during endoscopy (n = 2); a baseline whole-body gamma camera scan was done 4 hours later and on days 1 to 5.
  
  
  RESULTS
  The normal 3-day bile salt retention is 30% to 70% of baseline and normal adult biological half-life, t½ is 62 ± 17 hours. The results in children with a stoma were very low (0.1% at 7.6 hours; 5% at 17 hours). The children with reversed stoma had retention and t½ closer to the reference range (18% at 29 hours; 22% at 33 hours). The child with PFIC + biliary diversion had an initial very high gamma emission from the stoma bag suggesting excellent reabsorption of bile salts from his TI, but retention was 0.6% and t½ 9.8 hours, demonstrating efficient biliary diversion.
  
  
  CONCLUSIONS
  These results confirm children with stomas malabsorb bile acids, which can be ameliorated after stoma closure. SeHCAT demonstrated that the biliary diversion was working well and may be helpful in preoperative assessment of abnormal EHC. The role of SeHCAT in SBTx requires further evaluation.
authors.affiliation: The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK. Electronic address: sue.beath@nhs.net.
authors.forename: S V
authors.initials: SV
authors.lastname: Beath
authors.affiliation: Nuclear Medicine/Radiology Department, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: E
authors.initials: E
authors.lastname: Lanchbury
authors.affiliation: Radiology Department, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Alton
authors.affiliation: Nuclear Medicine/Radiology Department, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Mahandru
authors.affiliation: Nuclear Medicine/Radiology Department, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Toy
authors.affiliation: The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK.
authors.forename: I D
authors.initials: ID
authors.lastname: van Mouirk
authors.affiliation: The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: McKiernan
authors.affiliation: The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hartley
authors.affiliation: The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK.
authors.forename: D A
authors.initials: DA
authors.lastname: Kelly
authors.affiliation: The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK.
authors.forename: K
authors.initials: K
authors.lastname: Sharif
authors.affiliation: The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK.
authors.forename: G
authors.initials: G
authors.lastname: Gupte
mesh_terms: D000328:Adult; D001647:Bile Acids and Salts; D002780:Cholestasis, Intrahepatic / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D008297:Male; D010865:Pilot Projects; D011877:Radionuclide Imaging; D012644:Selenium Radioisotopes; D013656:Taurocholic Acid / Q000031:analogs & derivatives*; D066027:Transplant Recipients
chemical_list: D001647:Bile Acids and Salts; D012644:Selenium Radioisotopes; D013656:Taurocholic Acid; C033638:23-seleno-25-homotaurocholic acid