Serum citrulline and rejection in small bowel transplantation: A preliminary report

Peter A. Pappas, Jean Marie Saudubray, Andreas G. Tzakis, Daniel Rabier, Manuel R. Carreno, Orlando Gomez-Marin, Frans Huijing, Barry Gelman, David M. Levi, Jose R. Nery, Tomoaki Kato, Naveen Mittal, Seigo Nishida, John F. Thompson, Phillip Ruiz

Research output: Contribution to journalArticlepeer-review

59 Scopus citations


Background. There is no known serum marker for intestinal rejection. Serum concentrations of the amino acid citrulline arise almost exclusively from the intestinal mucosa. We examined the impact of acute cellular rejection (ACR) of intestinal allografts on serum citrulline levels. Methods. Citrulline concentrations were assayed in serum samples of healthy volunteers (n=6) and seven patients who underwent small bowel transplants (SBTx). Trends in mean citrulline concentrations versus degree of ACR were assessed by matching posttransplantation citrulline concentrations with patients' grade of ACR at time of serum collection. Rejection was confirmed by biopsy and graded by following standardized criteria. An additional patient had citrulline concentrations determined for 31 sequential specimens 3-60 days posttransplant. Results. Mean citrulline concentrations in controls were significantly higher than posttransplantation samples at any rejection grade. Mean concentrations declined significantly as rejection severity increased. The overall downward trend was statistically significant (P<0.05). In sequential measurements, citrulline levels increased significantly over time with declining severity of rejection. The increase in mean citrulline concentration between posttransplant days 3-16 and 52-60 was significant (P<0.01). Conclusions. Serum citrulline levels decline with increasing grade of ACR and may be a useful serum marker for intestinal rejection.

Original languageEnglish (US)
Pages (from-to)1212-1216
Number of pages5
Issue number7
StatePublished - Oct 15 2001
Externally publishedYes

ASJC Scopus subject areas

  • Transplantation


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