Valor crítico da citrulina para as complicações do enxerto no transplante de intestino

Translated title of the contribution: Critical value of citrulline for complications of intestinal transplant graft

André Ibrahim David, Luiz Arnaldo Szutan, Jeffrey Gaynor, Phillip Ruiz, Gennaro Selvaggi, Panagiotis Tryphonopoulos, Gary Kleiner, Jang I. Moon, Seigo Nishida, Debbie Weppler, Violet Squenazi, Lobella Conanan, David M. Levi, Tomoaki Kato, Andreas G. Tzakis

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE. A biochemical marker for detection of acute cellular rejection following small intestine transplantation has been sought. Citrulline, a non-protein amino acid synthesized mainly by functioning enterocytes, has been proposed. Trial sensitivity has been reportedly high but with low specificity. Thus, the goal was to determine, in a sufficiently large analysis, the significant value of citrulline level in the post-transplant setting, which would correlate with complications such as rejection and infection. METHODS. Since March, 2004 2,135 dried blood spot (DBS) citrulline samples were obtained from 57 small intestine transplant recipients three months or more after post-transplant, i.e., once the expected period of recovery in the citrulline levels had occurred. RESULTS. Using a <13 vs. ≥ 13μmoles/L cut off point, sensitivity of DBS citrulline for the detection of moderate or severe ACR was extremely high (96.4%). Furthermore, specificity estimates (given the absence of ACR and these particular infections), while controlling for time-to-DBS sample were reasonably high (54%-74% in children and 83%-88% in adults), and the negative predictive value (NPV) was >99%. CONCLUSION. Citrulline is a non-invasive marker to evaluate problems of the intestinal graft after three months post-transplant. Due to the high NPV, a moderate or severe ACR can be ruled out, based exclusively on knowledge of a high value for DBS citrulline.

Original languageUndefined/Unknown
Pages (from-to)426-429
Number of pages4
JournalRevista da Associacao Medica Brasileira
Volume54
Issue number5
DOIs
StatePublished - Sep 1 2008
Externally publishedYes

Fingerprint

Citrulline
Transplants
Small Intestine
Enterocytes
Transplantation
Biomarkers
Amino Acids
Infection

Keywords

  • Intestinal graft
  • Intestinal transplant
  • Rejection and citrulline

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Valor crítico da citrulina para as complicações do enxerto no transplante de intestino. / David, André Ibrahim; Szutan, Luiz Arnaldo; Gaynor, Jeffrey; Ruiz, Phillip; Selvaggi, Gennaro; Tryphonopoulos, Panagiotis; Kleiner, Gary; Moon, Jang I.; Nishida, Seigo; Weppler, Debbie; Squenazi, Violet; Conanan, Lobella; Levi, David M.; Kato, Tomoaki; Tzakis, Andreas G.

In: Revista da Associacao Medica Brasileira, Vol. 54, No. 5, 01.09.2008, p. 426-429.

Research output: Contribution to journalArticle

David, AI, Szutan, LA, Gaynor, J, Ruiz, P, Selvaggi, G, Tryphonopoulos, P, Kleiner, G, Moon, JI, Nishida, S, Weppler, D, Squenazi, V, Conanan, L, Levi, DM, Kato, T & Tzakis, AG 2008, 'Valor crítico da citrulina para as complicações do enxerto no transplante de intestino', Revista da Associacao Medica Brasileira, vol. 54, no. 5, pp. 426-429. https://doi.org/10.1590/S0104-42302008000500016
David, André Ibrahim ; Szutan, Luiz Arnaldo ; Gaynor, Jeffrey ; Ruiz, Phillip ; Selvaggi, Gennaro ; Tryphonopoulos, Panagiotis ; Kleiner, Gary ; Moon, Jang I. ; Nishida, Seigo ; Weppler, Debbie ; Squenazi, Violet ; Conanan, Lobella ; Levi, David M. ; Kato, Tomoaki ; Tzakis, Andreas G. / Valor crítico da citrulina para as complicações do enxerto no transplante de intestino. In: Revista da Associacao Medica Brasileira. 2008 ; Vol. 54, No. 5. pp. 426-429.
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abstract = "OBJECTIVE. A biochemical marker for detection of acute cellular rejection following small intestine transplantation has been sought. Citrulline, a non-protein amino acid synthesized mainly by functioning enterocytes, has been proposed. Trial sensitivity has been reportedly high but with low specificity. Thus, the goal was to determine, in a sufficiently large analysis, the significant value of citrulline level in the post-transplant setting, which would correlate with complications such as rejection and infection. METHODS. Since March, 2004 2,135 dried blood spot (DBS) citrulline samples were obtained from 57 small intestine transplant recipients three months or more after post-transplant, i.e., once the expected period of recovery in the citrulline levels had occurred. RESULTS. Using a <13 vs. ≥ 13μmoles/L cut off point, sensitivity of DBS citrulline for the detection of moderate or severe ACR was extremely high (96.4{\%}). Furthermore, specificity estimates (given the absence of ACR and these particular infections), while controlling for time-to-DBS sample were reasonably high (54{\%}-74{\%} in children and 83{\%}-88{\%} in adults), and the negative predictive value (NPV) was >99{\%}. CONCLUSION. Citrulline is a non-invasive marker to evaluate problems of the intestinal graft after three months post-transplant. Due to the high NPV, a moderate or severe ACR can be ruled out, based exclusively on knowledge of a high value for DBS citrulline.",
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T1 - Valor crítico da citrulina para as complicações do enxerto no transplante de intestino

AU - David, André Ibrahim

AU - Szutan, Luiz Arnaldo

AU - Gaynor, Jeffrey

AU - Ruiz, Phillip

AU - Selvaggi, Gennaro

AU - Tryphonopoulos, Panagiotis

AU - Kleiner, Gary

AU - Moon, Jang I.

AU - Nishida, Seigo

AU - Weppler, Debbie

AU - Squenazi, Violet

AU - Conanan, Lobella

AU - Levi, David M.

AU - Kato, Tomoaki

AU - Tzakis, Andreas G.

PY - 2008/9/1

Y1 - 2008/9/1

N2 - OBJECTIVE. A biochemical marker for detection of acute cellular rejection following small intestine transplantation has been sought. Citrulline, a non-protein amino acid synthesized mainly by functioning enterocytes, has been proposed. Trial sensitivity has been reportedly high but with low specificity. Thus, the goal was to determine, in a sufficiently large analysis, the significant value of citrulline level in the post-transplant setting, which would correlate with complications such as rejection and infection. METHODS. Since March, 2004 2,135 dried blood spot (DBS) citrulline samples were obtained from 57 small intestine transplant recipients three months or more after post-transplant, i.e., once the expected period of recovery in the citrulline levels had occurred. RESULTS. Using a <13 vs. ≥ 13μmoles/L cut off point, sensitivity of DBS citrulline for the detection of moderate or severe ACR was extremely high (96.4%). Furthermore, specificity estimates (given the absence of ACR and these particular infections), while controlling for time-to-DBS sample were reasonably high (54%-74% in children and 83%-88% in adults), and the negative predictive value (NPV) was >99%. CONCLUSION. Citrulline is a non-invasive marker to evaluate problems of the intestinal graft after three months post-transplant. Due to the high NPV, a moderate or severe ACR can be ruled out, based exclusively on knowledge of a high value for DBS citrulline.

AB - OBJECTIVE. A biochemical marker for detection of acute cellular rejection following small intestine transplantation has been sought. Citrulline, a non-protein amino acid synthesized mainly by functioning enterocytes, has been proposed. Trial sensitivity has been reportedly high but with low specificity. Thus, the goal was to determine, in a sufficiently large analysis, the significant value of citrulline level in the post-transplant setting, which would correlate with complications such as rejection and infection. METHODS. Since March, 2004 2,135 dried blood spot (DBS) citrulline samples were obtained from 57 small intestine transplant recipients three months or more after post-transplant, i.e., once the expected period of recovery in the citrulline levels had occurred. RESULTS. Using a <13 vs. ≥ 13μmoles/L cut off point, sensitivity of DBS citrulline for the detection of moderate or severe ACR was extremely high (96.4%). Furthermore, specificity estimates (given the absence of ACR and these particular infections), while controlling for time-to-DBS sample were reasonably high (54%-74% in children and 83%-88% in adults), and the negative predictive value (NPV) was >99%. CONCLUSION. Citrulline is a non-invasive marker to evaluate problems of the intestinal graft after three months post-transplant. Due to the high NPV, a moderate or severe ACR can be ruled out, based exclusively on knowledge of a high value for DBS citrulline.

KW - Intestinal graft

KW - Intestinal transplant

KW - Rejection and citrulline

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