DIAGNOSIS OF PANCREATIC ALLOGRAFT REJECTION BY MEASUREMENT OF URINARY RADIOIMMUNOREACTIVE INSULIN

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Abstract
The accurate, early, and sensitive diagnosis of pancreatic allograft rejection is one of the major problems in clinical pancreas transplantation today. Pancreaticocystotomy is a popular technique for pancreas transplantation that permits simple and frequent urinary chemistry examinations. In this experiment, 20 mongrel dogs with a bladder-drained pancreatic transplant had serial monitoring of urinary amylase (UA) and urinary insulin (UI). The mean UI in the nonrejection state was 9.6±12 mIU/L. In eight dogs varying degrees of rejection were documented by histopathology. All three animals having severe acute rejection had high levels of IU (all>300–800 mIU/L). Of the five animals with mild-to-moderate rejection, all had significant UI elevations to >100 mIU/L but none had elevations above 200 mIU/L (P14 days, during which the mean UI was extremely low (11±6.4 mIU/L, PP300 mIU/L). None of the animals with grafts surviving to rejection at seven days or more had these early severe elevations, and thus