Defining Normal Plasma Citrulline in Intestinal Transplant Recipients

Gabriel E. Gondolesi, Stuart S. Kaufman, Claude Sansaricq, Margret S. Magid, Kimiyo Raymond, Liesl P. Iledan, Ye Tao, Sander S. Florman, Neal S. LeLeiko, Thomas M. Fishbein

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27 Scopus citations


Biopsy is the only means to identify intestinal graft rejection. Plasma citrulline (P-Cit) has been proposed as a marker for rejection after intestinal transplant (IT), but normative data is lacking. We analyzed P-Cit in IT recipients without rejection or other histological abnormalities. In 40 patients, P-Cit was measured with a Beckman amino acid analyzer within 24 h of protocol or clinically indicated endoscopic biopsy procured > 6 and < 360 days post-IT. Measurements included for analysis corresponded to normal (or minimally abnormal) biopsies that remained so for 7 days. These criteria were met by 145 samples from 10 adults and 14 children. Overall mean P-Cit (nmol/mL) was 34.0 ± 19.9. Mean P-Cit was 22.2 ± 13.2 between 6 and 30 days post-IT, 34.9 ± 17.2 (p = 0.001) between 30 and 60 days, 43.6 ± 15.8 between 60 and 90 days (p = 0.001), then stable until the end of the first year. Plasma citrulline was lower in 13 patients with body surface area (BSA) ≤ 1 m2 vs. 11 patients with BSA ≥ 1.1 m2 (p = 0.0001). Plasma citrulline increased linearly during the first 120 days in both BSA groups (r = 0.573 and r = 0.512; p = 0.0001). Within 3 months after IT, variations in P-Cit based on body size and postop interval should be considered when evaluating the need for histological confirmation of graft dysfunction.

Original languageEnglish
Pages (from-to)414-418
Number of pages5
JournalAmerican Journal of Transplantation
Issue number3
StatePublished - Mar 2004


  • Citrulline
  • Dysfunction
  • Intestine
  • Rejection
  • Transplant


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