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 journalArticlepeer-review

2 Scopus citations


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.

Translated title of the contributionCritical value of citrulline for complications of intestinal transplant graft
Original languagePortuguese
Pages (from-to)426-429
Number of pages4
JournalRevista da Associacao Medica Brasileira
Issue number5
StatePublished - Sep 2008
Externally publishedYes


  • Intestinal graft
  • Intestinal transplant
  • Rejection and citrulline

ASJC Scopus subject areas

  • Medicine(all)


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