Stool calprotectin monitoring after small intestine transplantation.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Mercer, DF; Vargas, L; Sun, Y; Moreno, AMA; Grant, WJ; Botha, JF; Langnas, AN; Sudan, DL

Published Date

  • May 27, 2011

Published In

Volume / Issue

  • 91 / 10

Start / End Page

  • 1166 - 1171

PubMed ID

  • 21460762

Pubmed Central ID

  • 21460762

Electronic International Standard Serial Number (EISSN)

  • 1534-6080

Digital Object Identifier (DOI)

  • 10.1097/TP.0b013e318215e709

Language

  • eng

Conference Location

  • United States