Stool calprotectin monitoring after small intestine transplantation

David F Mercer, Luciano M Vargas, Yimin Sun, Ane M Andres Moreno, Wendy J. Grant, Jean F. Botha, Alan Norman Langnas, Debra L. Sudan

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Small intestine transplantation is the only life-saving therapy available for patients with intestinal failure and life-threatening complications of parenteral nutrition, but it is still plagued by high levels of early acute rejection. The ability to diagnose rejection noninvasively, ideally before pathologic manifestations, would be a major advance in the care of intestinal transplant patients. Methods: We measured calprotectin levels in 732 stool samples collected, analyzed over from 72 patients having undergone 74 total transplants, and correlated them with clinical indications, ostomy output, and pathologic findings. Results: We found that overall patients with rejection have higher mean levels of stool calprotectin than those without, but because of significant interpatient variability, defining an effective general "cutoff" for the test is difficult. Each patient, in effect, has to act as their own control. Patients experiencing rejection episodes have greater fluctuations in calprotectin levels than those without, suggesting increased "reactivity" within the graft. Our most frequent clinical indicator for biopsy, an increase in ostomy output, had no real relationship to the discovery of rejection. Conclusion: Although more frequent prospective sampling could perhaps demonstrate an advantage in early indication of rejection, based on these data, routine stool calprotectin monitoring is not strongly supported.

Original languageEnglish (US)
Pages (from-to)1166-1171
Number of pages6
JournalTransplantation
Volume91
Issue number10
DOIs
StatePublished - May 27 2011

Fingerprint

Leukocyte L1 Antigen Complex
Small Intestine
Transplantation
Ostomy
Transplants
Parenteral Nutrition
Biopsy

Keywords

  • Calprotectin
  • Noninvasive monitoring
  • Rejection
  • Small intestine transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Mercer, D. F., Vargas, L. M., Sun, Y., Moreno, A. M. A., Grant, W. J., Botha, J. F., ... Sudan, D. L. (2011). Stool calprotectin monitoring after small intestine transplantation. Transplantation, 91(10), 1166-1171. https://doi.org/10.1097/TP.0b013e318215e709

Stool calprotectin monitoring after small intestine transplantation. / Mercer, David F; Vargas, Luciano M; Sun, Yimin; Moreno, Ane M Andres; Grant, Wendy J.; Botha, Jean F.; Langnas, Alan Norman; Sudan, Debra L.

In: Transplantation, Vol. 91, No. 10, 27.05.2011, p. 1166-1171.

Research output: Contribution to journalArticle

Mercer, David F ; Vargas, Luciano M ; Sun, Yimin ; Moreno, Ane M Andres ; Grant, Wendy J. ; Botha, Jean F. ; Langnas, Alan Norman ; Sudan, Debra L. / Stool calprotectin monitoring after small intestine transplantation. In: Transplantation. 2011 ; Vol. 91, No. 10. pp. 1166-1171.
@article{4ab75ba3fa6049f69037c62500e1e953,
title = "Stool calprotectin monitoring after small intestine transplantation",
abstract = "Background: Small intestine transplantation is the only life-saving therapy available for patients with intestinal failure and life-threatening complications of parenteral nutrition, but it is still plagued by high levels of early acute rejection. The ability to diagnose rejection noninvasively, ideally before pathologic manifestations, would be a major advance in the care of intestinal transplant patients. Methods: We measured calprotectin levels in 732 stool samples collected, analyzed over from 72 patients having undergone 74 total transplants, and correlated them with clinical indications, ostomy output, and pathologic findings. Results: We found that overall patients with rejection have higher mean levels of stool calprotectin than those without, but because of significant interpatient variability, defining an effective general {"}cutoff{"} for the test is difficult. Each patient, in effect, has to act as their own control. Patients experiencing rejection episodes have greater fluctuations in calprotectin levels than those without, suggesting increased {"}reactivity{"} within the graft. Our most frequent clinical indicator for biopsy, an increase in ostomy output, had no real relationship to the discovery of rejection. Conclusion: Although more frequent prospective sampling could perhaps demonstrate an advantage in early indication of rejection, based on these data, routine stool calprotectin monitoring is not strongly supported.",
keywords = "Calprotectin, Noninvasive monitoring, Rejection, Small intestine transplantation",
author = "Mercer, {David F} and Vargas, {Luciano M} and Yimin Sun and Moreno, {Ane M Andres} and Grant, {Wendy J.} and Botha, {Jean F.} and Langnas, {Alan Norman} and Sudan, {Debra L.}",
year = "2011",
month = "5",
day = "27",
doi = "10.1097/TP.0b013e318215e709",
language = "English (US)",
volume = "91",
pages = "1166--1171",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Stool calprotectin monitoring after small intestine transplantation

AU - Mercer, David F

AU - Vargas, Luciano M

AU - Sun, Yimin

AU - Moreno, Ane M Andres

AU - Grant, Wendy J.

AU - Botha, Jean F.

AU - Langnas, Alan Norman

AU - Sudan, Debra L.

PY - 2011/5/27

Y1 - 2011/5/27

N2 - Background: Small intestine transplantation is the only life-saving therapy available for patients with intestinal failure and life-threatening complications of parenteral nutrition, but it is still plagued by high levels of early acute rejection. The ability to diagnose rejection noninvasively, ideally before pathologic manifestations, would be a major advance in the care of intestinal transplant patients. Methods: We measured calprotectin levels in 732 stool samples collected, analyzed over from 72 patients having undergone 74 total transplants, and correlated them with clinical indications, ostomy output, and pathologic findings. Results: We found that overall patients with rejection have higher mean levels of stool calprotectin than those without, but because of significant interpatient variability, defining an effective general "cutoff" for the test is difficult. Each patient, in effect, has to act as their own control. Patients experiencing rejection episodes have greater fluctuations in calprotectin levels than those without, suggesting increased "reactivity" within the graft. Our most frequent clinical indicator for biopsy, an increase in ostomy output, had no real relationship to the discovery of rejection. Conclusion: Although more frequent prospective sampling could perhaps demonstrate an advantage in early indication of rejection, based on these data, routine stool calprotectin monitoring is not strongly supported.

AB - Background: Small intestine transplantation is the only life-saving therapy available for patients with intestinal failure and life-threatening complications of parenteral nutrition, but it is still plagued by high levels of early acute rejection. The ability to diagnose rejection noninvasively, ideally before pathologic manifestations, would be a major advance in the care of intestinal transplant patients. Methods: We measured calprotectin levels in 732 stool samples collected, analyzed over from 72 patients having undergone 74 total transplants, and correlated them with clinical indications, ostomy output, and pathologic findings. Results: We found that overall patients with rejection have higher mean levels of stool calprotectin than those without, but because of significant interpatient variability, defining an effective general "cutoff" for the test is difficult. Each patient, in effect, has to act as their own control. Patients experiencing rejection episodes have greater fluctuations in calprotectin levels than those without, suggesting increased "reactivity" within the graft. Our most frequent clinical indicator for biopsy, an increase in ostomy output, had no real relationship to the discovery of rejection. Conclusion: Although more frequent prospective sampling could perhaps demonstrate an advantage in early indication of rejection, based on these data, routine stool calprotectin monitoring is not strongly supported.

KW - Calprotectin

KW - Noninvasive monitoring

KW - Rejection

KW - Small intestine transplantation

UR - http://www.scopus.com/inward/record.url?scp=79955615590&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955615590&partnerID=8YFLogxK

U2 - 10.1097/TP.0b013e318215e709

DO - 10.1097/TP.0b013e318215e709

M3 - Article

C2 - 21460762

AN - SCOPUS:79955615590

VL - 91

SP - 1166

EP - 1171

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 10

ER -