Serum lipase as a marker for pancreatic allograft rejection

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Abstract
In patients with enteric drainage of pancreas transplants, urinary amylase cannot be used as a marker of rejection. Since most of the patients in our center have enteric drainage, the aim of this study was to evaluate serum lipase as a potential marker for rejection. From July 1994 to March 1997, 100 patients underwent pancreas transplantation with enteric (78) or bladder (22) drainage. Forty‐two of the 100 patients had both daily serum lipase (sLip) values and either kidney core or fine needle aspiration biopsies of the pancreas and/or kidney. Thirty‐one of the 42 had biopsy proven rejection and were treated on day 0 (D0). From day ‐ 7 (D‐7) to day + 7 (D+7), sLip, serum amylase (sAmy), fasting blood sugar (FBS) and serum creatinine (sCr) were measured daily. Serum lipase values rose from 322 + 107 IU/L on D ‐2 to 634 +247 IU/L on D‐1 (p=0.0203) in 22 of the 31 patients with biopsy proven rejection (sensitivity 71%). The rise in sCr in combined kidney pancreas transplants with biopsy proven rejection was a better marker than sLip (sensitivity 86%). The sensitivity of sAmy and FBS was 50 and 33%, respectively. Other than sCr, sLip appeared to be the best marker for acute rejection in enterically drained pancreas transplants which should be useful as a non‐invasive indicator of rejection in solitary pancreas transplants where sCr cannot be used.