Hot topics in postsmall bowel transplantation: Noninvasive graft monitoring including stool calprotectin and plasma citrulline

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Abstract

Purpose of review: Long-term success in intestinal transplantation could be significantly improved by the development of a reliable noninvasive marker of rejection, allowing early diagnosis and treatment without the need for repeated biopsy procedures. Recent findings: At present, no single test appears sufficiently reliable to replace the need for invasive testing. Falling plasma citrulline levels may correlate with mucosal damage already done, but do not appear to be specific for rejection or provide clinically useful prediction of an event in advance of its occurrence. Similarly, rising stool calprotectin levels are correlated with pathologic diagnosis of rejection, but do not appear to have sufficient predictive value. Both tests appear to be best described as exclusionary, in that if their values are 'normal', rejection is less likely, but each is hampered by wide variability within and between patients. Summary: These approaches and others are reviewed in an outline of the current progress towards developing a clinically useful noninvasive tool for graft monitoring.

Original languageEnglish (US)
Pages (from-to)316-322
Number of pages7
JournalCurrent opinion in organ transplantation
Volume16
Issue number3
DOIs
StatePublished - Jun 2011

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Accidental Falls
Leukocyte L1 Antigen Complex
Citrulline
Early Diagnosis
Reference Values
Transplantation
Transplants
Biopsy
Therapeutics

Keywords

  • noninvasive monitoring
  • rejection
  • small intestine transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation

Cite this

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abstract = "Purpose of review: Long-term success in intestinal transplantation could be significantly improved by the development of a reliable noninvasive marker of rejection, allowing early diagnosis and treatment without the need for repeated biopsy procedures. Recent findings: At present, no single test appears sufficiently reliable to replace the need for invasive testing. Falling plasma citrulline levels may correlate with mucosal damage already done, but do not appear to be specific for rejection or provide clinically useful prediction of an event in advance of its occurrence. Similarly, rising stool calprotectin levels are correlated with pathologic diagnosis of rejection, but do not appear to have sufficient predictive value. Both tests appear to be best described as exclusionary, in that if their values are 'normal', rejection is less likely, but each is hampered by wide variability within and between patients. Summary: These approaches and others are reviewed in an outline of the current progress towards developing a clinically useful noninvasive tool for graft monitoring.",
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