PLASMA PANCREATIC SECRETORY TRYPSIN-INHIBITOR AS A MARKER OF PANCREAS GRAFT-REJECTION AFTER COMBINED PANCREAS-KIDNEY TRANSPLANTATION

One of the major problems in clinical pancreas transplantation is the lack of a simple and sensitive marker for detecting the early process of allograft rejection. Plasma pancreatic secretory trypsin inhibitor (p-PSTI) levels were measured in recipients of combined pancreas-kidney transplants (SPKT) and isolated cadaveric renal transplants (CRT) as controls. In the postoperative courses of SPKT recipients without acute rejection episodes and any other complications, high preoperative and immediate postoperative concentrations of p-PSTI gradually declined from the third day after transplantation and returned to the baseline level (< 87.9 ng/ml) by the 6th day, and then remained unchanged. In this study, 11 out of 17 SPKT recipients experienced 13 acute rejection episodes. Early in the rejection course, p-PSTI levels increased significantly (P < 0.05) 1 day before the initial day of diagnosed rejection (peak value; 232.7 +/- 99.3 ng/ml), and then they decreased following antirejection therapy. In the control group, p-PSTI elevation was less dramatic (peak value: 70.5 +/- 22.8 ng/ml, P < 0.01) and did not precede the rise in serum creatinine. We conclude that p-PSTI may be an early, sensitive, and reliable marker of clinical pancreas graft rejection.