Long-term success in intestinal transplantation could be significantly improved by the development of a reliable noninvasive marker of rejection, allowing early diagnosis and treatment without the need for repeated biopsy procedures. So far, no marker in the sera of small bowel transplant recipients is available. Kynurenine (Kyn) is a product of the tryptophan pathway and elevated in inflammation and T-cell activation as shown in renal transplantation.

We investigated the role of Kyn in the sera of a small bowel transplant recipient.

Material and Method

A 29 year old male patient suffering from a neuronal intestinal dysplasia received a full small bowel allograft together with the right colon. Immunosuppressive therapy consisted of ATG, TAC, MMF and MP.

Daily levels of Kyn were monitored and graft biopsies were taken every other day.

Results

Kyn before transplantation as 1.7 mM (normal range <2,5 mM). On day 3 POD Kyn rose significantly to 5.8 mM and wound drainage showed a severe infection with candida. The patient was taken to the OR and an abdominal lavage was done. The candida infection could be cleared and Kyn levels dropped to near normal values. On day 10 POD Kyn level again rose to 5.3 mM and a graft biopsy on day 11 POD showed an acute cellular rejection grade 1. Thymoglobulin therapy was initiated and Kyn levels again dropped to near normal values. Further biopsies showed no signs of rejection.

Summary

Kyn level in the sera of a small bowel transplant recipient showed a good correlation with clinical infection and allograft rejection episodes.

Kyn may serve as a valuable marker for the monitoring of small bowel allografts.

CITATION INFORMATION: Stangl M., Koliogiannis D., Bucher J., Guba M., Abendroth D. Monitoring of Small Bowel Allografts with Kynurenine Serum Levels Am J Transplant. 2017;17 (suppl 3).

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