Blood citrulline level is an exclusionary marker for significant acute rejection after intestinal transplantation.
Transplantation
; 84(9): 1077-81, 2007 Nov 15.
Article
en En
| MEDLINE
| ID: mdl-17998860
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 multivariableanalysis:
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.
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Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Citrulina
/
Rechazo de Injerto
/
Intestinos
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
/
Male
Idioma:
En
Revista:
Transplantation
Año:
2007
Tipo del documento:
Article
País de afiliación:
Estados Unidos