Beta cell specific cell free DNA and trypsinogen for the diagnosis of rejection in pancreas transplantation: update on the EMPAR study [Abstract]

Tteralli, N., Mortimer, G., Eberl, M., Dayan, C. ORCID: https://orcid.org/0000-0002-6557-3462, Martinez-Sanchez, A., Gillespie, K. and Asderakis, A. 2026. Beta cell specific cell free DNA and trypsinogen for the diagnosis of rejection in pancreas transplantation: update on the EMPAR study [Abstract]. American Journal of Transplantation 26 (7 S1) , S332. 10.1016/j.ajt.2026.05.385

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Abstract

Purpose: Pancreas transplant rejection is difficult to diagnose with amylase neither sensitive nor specific. Beta cell specific cell-free DNA (b-cfDNA) is a biomarker associated with beta cell damage or death and trypsinogen is a marker of pancreatitis. Both might be useful in the diagnosis of rejection Methods: EMPAR is the first prospective study examining the role of a combination of biomarkers for pancreas rejection: b-cfDNA, trypsinogen and micro RNAs. 14 patients for new SPK transplant (9 proceeded) and 14 admitted with suspicion of rejection or infection were recruited so far. New transplants were sampled pretransplant, post perfusion, discharge, and monthly thereafter whereas admitted ones on admission, treatment and monthly after. Results were associated with the presence of biopsy proven rejection or an alternative diagnosis. Unmethylated b-cfDNA was identified in copies per ml (cp/ml) by droplet digital PCR. Trypsinogen was measured with an adapted Delfia Neonatal IRT kit. Results: In tested samples the pre-perfusion trypsinogen level was 109 ng/ml (66-223) and raised to 450 post-perfusion; at 3 months post-transplant was 41 (18-88). In 7 patients with rejection trypsinogen was 122 (11-320) which was increased compared to 3-months post-transplant in stable patients but with overlapping. The 1-month post-transplant b-cfDNA was 108 cp/ml same as in month 3. In 9 patients with rejection b-cfDNA raised to a median of 273 cp/ml (95% CI 165 to 379) on the admission pre-biopsy day and dropped to 106 cp/ml 1 month following rejection treatment. This compared to 92 cp/ml in admitted patients without rejection and 83 in the combined patients who were admitted without rejection or had stable function 1-month post-transplant (95% CI 53 to 130, p=0.027).

Item Type:	Short Communication
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by-nc-nd/4.0/, Start Date: 2027-06-19
Publisher:	Elsevier
ISSN:	1600-6135
Date of First Compliant Deposit:	26 June 2026
Last Modified:	08 Jul 2026 09:00
URI:	https://orca.cardiff.ac.uk/id/eprint/187754

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