INVESTIGADORES
CHIRDO Fernando Gabriel
artículos
Título:
Evaluation of Calprotectin Level in Intestinal Content as an Early Marker for Graft Rejection
Autor/es:
CAGNOLA H; SCARAVONATI R; CABANNE A; BIANCHI C; CRUZ F; ERREA A; ZAMBERNARDI A; MEIER D; CHIRDO F; DOCENA G; GONDOLESI G; RUMBO M
Revista:
TRANSPLANTATION PROCEEDINGS
Editorial:
ELSEVIER SCIENCE INC
Referencias:
Lugar: Nueva York; Año: 2010 vol. 42 p. 57 - 61
ISSN:
0041-1345
Resumen:
Introduction. The diagnosis of rejection after intestinal transplantation is still performed
by endoscopic biopsy monitoring. Less invasive diagnostic procedures are desirable,
although they are not available so far. Calprotectin, a stable cytosolic granulocyte protein,
which previously was used as a marker of inflammatory processes, has been proposed to be
a biochemical marker for rejection. The aim of the present work was to analyze the
concordance between calprotectin levels in intestinal content and the presence of graft
rejection after small bowel transplantation.
Methods. Calprotectin level was measured using a commercial ELISA kit on 137
samples of intestinal content randomly collected during endoscopies performed on 11
intestinal transplantation patients during 2 years follow-up. Calprotectin determinations
were correlated with histological and clinical findings. The cut-off level was determined
retrospectively by receiver-operator curve analysis.
Results. Based on histological findings and clinical records, samples were discerned as
rejection positive (37 of 137), versus negative (35 of 137) samples or those with no clinical,
endoscopic, or histological findings (65 of 137 samples). A cut-off value of 65 _g of
calprotectin/g of intestinal content provided the best assay parameter according to the
clinical findings: a 76% sensitivity and a 47% specificity. False positive results corresponded
to patients with gastrointestinal infections (13%), systemic infections (13%),
ulcers (10%), or nonspecific histological alterations of the mucosa (15%). The other false
positive cases corresponded to postsurgical samples (4%), or patients with concomitant
gastrointestinal symptoms (2%). Most false negative results (78%) were observed during
recovery from severe acute rejection episodes, among successfully treated patients. In
these cases, epithelial reconstitution and no mucosal infiltration was observed. If the latter
group were discarded, sensitivity rose to 93%, and specificity, to 50% with a 96% negative
predictive value. Furthermore, a weak correlation was observed between calprotectin
levels and the severity of rejection.
Conclusions. This study confirmed the results obtained by other groups: fecal calprotectin
dosage showed a good sensitivity but low specificity for the diagnosis of intestinal