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Published on: November 6, 2012
Immunoreactive trypsinogen levels in pediatric patients with intestinal failure awaiting intestinal transplantation
G M Rovera1, L Sigurdsson, J Reyes
1Department of Pediatrics, Children's Hospital of Pittsburgh, and Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA 15213-2583, USA.
Insights
Elevated immunoreactive trypsinogen (IRT) levels are common in children with intestinal failure. However, these IRT levels do not predict post-transplant pancreatitis risk in these patients.
Area of Science:
- Pediatric Gastroenterology
- Pancreatic Physiology
- Intestinal Failure Research
Background:
- Children with permanent intestinal failure often require total parenteral nutrition (TPN).
- Assessing pancreatic function is crucial in managing these complex pediatric cases.
- Elevated immunoreactive trypsinogen (IRT) may indicate pancreatic stress or dysfunction.
Purpose of the Study:
- To evaluate pancreatic function in TPN-dependent children with permanent intestinal failure.
- To assess the utility of measuring immunoreactive trypsinogen (IRT) levels.
- To determine if IRT levels can predict post-transplant pancreatitis.
Main Methods:
- Retrospective analysis of serum samples from 55 pediatric patients with permanent intestinal failure.
- Measurement of immunoreactive trypsinogen (IRT) levels.
- Comparison of IRT levels between patients with short bowel syndrome (SBS) and controls.
Main Results:
- IRT levels were significantly higher in SBS patients compared to controls (p < 0.001).
- IRT levels did not correlate with liver injury, bowel length, or SBS etiology.
- Five of 20 intestinal transplant recipients developed pancreatitis post-operatively; IRT levels did not predict this.
Conclusions:
- Elevated plasma IRT levels are frequent in children with intestinal failure.
- IRT levels are not a reliable predictor of post-transplant pancreatitis in this population.
- Further research is needed to identify reliable biomarkers for pancreatitis risk.
Abstract:
The aim of this study was to evaluate pancreatic function in total parenteral nutrition (TPN)-dependent children with permanent intestinal failure by measuring immunoreactive trypsinogen (IRT) levels. Between 1992 and 1996, 105 pediatric patients with permanent intestinal failure were referred to the Children's Hospital of Pittsburgh for small intestinal transplant evaluation. Serum samples were available from 55 of them. Ten suffered from intestinal pseudo-obstruction or microvillus inclusion disease, while 45 had short bowel syndrome (SBS). IRT levels were significantly higher (p < 0.001) in SBS patients (89.4 +/- 9.2 ng mL) compared to controls (43.4 +/- 5.6 ng/ nL) without liver, gastrointestinal, or kidney disease. IRT levels did not correlate with liver injury, length of bowel, or the cause of SBS. Five of 20 patients who underwent intestinal transplantation developed pancreatitis during a median post-operative follow up 15.4 months later. IRT levels failed to predict who would develop pancreatitis post-transplant. The data suggest that elevated plasma IRT levels are common among children with intestinal failure, but fail to identify patients at risk for pancreatitis post-transplant.
