Abstract:
BACKGROUND:Serum citrulline is a marker for acute cellular rejection (ACR) after intestinal transplantation; however, its clinical utility has not yet been established. The goal of this study was to determine clearcut serum levels beyond which the diagnosis of acute rejection could be supported or refuted, and predictors of citrulline levels posttransplant from which more accurate estimates of sensitivity and specificity could be obtained. METHODS:Since March 2004, we obtained 2135 dried blood spot (DBS) citrulline samples from 57 intestinal transplant recipients at or beyond 3 months posttransplant. Stepwise linear regression was performed to determine the most significant multivariable predictors of the patient's DBS citrulline level. RESULTS:Seven characteristics were associated with a significantly lower citrulline in multivariable analysis: presence of mild, moderate, or severe ACR; presence of bacteremia or respiratory infection; pediatric age; and time from transplant to DBS sample (P<0.00001 in each case). Using a <13 vs. > or =13 micromoles/L cutoff point, the sensitivity for detecting moderate or severe ACR and the negative predictive value were high (96.4% and >99% respectively). Specificity was 54% to 74% in children and 83% to 88% in adults. CONCLUSIONS:Citrulline levels <13 micromoles/L should alert the clinical team that a serious problem (rejection or infection) could be looming in a previously stable intestinal recipient. Levels > =13 micromoles/L practically rule out moderate or severe rejection.
journal_name
Transplantationjournal_title
Transplantationauthors
David AI,Selvaggi G,Ruiz P,Gaynor JJ,Tryphonopoulos P,Kleiner GI,Moon JI,Nishida S,Pappas PA,Conanan L,Weppler D,Esquenazi V,Levi DM,Kato T,Tzakis AGdoi
10.1097/01.tp.0000287186.04342.82subject
Has Abstractpub_date
2007-11-15 00:00:00pages
1077-81issue
9eissn
0041-1337issn
1534-6080pii
00007890-200711150-00003journal_volume
84pub_type
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