PANCREAS-SPECIFIC PROTEIN (PASP), SERUM AMYLOID-A (SAA), AND NEOPTERIN (NEOP) IN THE DIAGNOSIS OF REJECTION AFTER SIMULTANEOUS PANCREAS ANDKIDNEY-TRANSPLANTATION

A reliable, noninvasive indicator of pancreatic allograft rejection is urgently needed. In this study, serum (S), plasma (P), and urine (U) levels of pancreas-specific protein (P-PASP, U-PASP), neopterin (S-NEO P, U-NEOP), amylase (U-AMYL), and amyloid A (SAA) were measured daily in ten type Il diabetic patients following simultaneous pancreas and k idney transplantation (SPK). Rejection episodes occurred in three isol ated pancreas, nine isolated kidney, and five simultaneous pancreas an d kidney transplants. In the case of the eight pancreas rejections, SA A was the rejection marker with the highest diagnostic accuracy (94 %) . Using P-PASP and U-PASP, an accuracy of 81 % and 79 %, respectively, was achieved, During viral infections, U-NEOP levels increased to a m aximum level of 1904 mu mol/mol creatinine, whereas during bacterial i nfections, SAA levels increased to a maximum value of 43 mg/dl. SAA, m easured for the first time in SPK, appears to be a valuable rejection parameter, In combination with U-NEOP and U-AMYL, a differential diagn osis between rejection, bacterial infection, and viral infection was p ossible. Neither U-PASP nor P-PASP monitoring led to a significant imp rovement in the results.