Selenium homocholic acid taurocholate scanning, selenium-75-labeled bile acid, a novel method for testing the function of the terminal ileum in small bowel transplant recipients: a pilot study.

Abstract

INTRODUCTION:

The terminal ileum (TI) is important for the active reabsorption of bile salts and is the site of allograft rejection; disruption of enterohepatic circulation (EHC) may give insights to inflammatory and other physiologic processes at the TI.

SUBJECTS AND METHODS:

Four children aged 5 to 12 years who had received small bowel transplantation (SBTx), 3 recovering from post-transplant lymphoproliferative disease (PTLD) and 1 with acute rejection, were studied. Two of the 4 had stoma reversal. Another child (15 years) with progressive familial intrahepatic cholestasis (PFIC) and pruritus, despite liver transplantation and biliary diversion, was studied. Selenium homocholic acid taurocholate scanning ((75)SeHCAT) capsule was given orally (n = 3) or via introducer during endoscopy (n = 2); a baseline whole-body gamma camera scan was done 4 hours later and on days 1 to 5.

RESULTS:

The normal 3-day bile salt retention is 30% to 70% of baseline and normal adult biological half-life, t½ is 62 ± 17 hours. The results in children with a stoma were very low (0.1% at 7.6 hours; 5% at 17 hours). The children with reversed stoma had retention and t½ closer to the reference range (18% at 29 hours; 22% at 33 hours). The child with PFIC + biliary diversion had an initial very high gamma emission from the stoma bag suggesting excellent reabsorption of bile salts from his TI, but retention was 0.6% and t½ 9.8 hours, demonstrating efficient biliary diversion.

CONCLUSION:

These results confirm children with stomas malabsorb bile acids, which can be ameliorated after stoma closure. SeHCAT demonstrated that the biliary diversion was working well and may be helpful in preoperative assessment of abnormal EHC. The role of SeHCAT in SBTx requires further evaluation.

• Authors: S V Beath, E Lanchbury, H Alton, R Mahandru, M Toy, I D van Mouirk, P J McKiernan, J Hartley, D A Kelly, K Sharif, G Gupte
• Journal: Transplantation proceedings (Transplant Proc) 2014 Jul-Aug Vol. 46 Issue 6 Pg. 2119-21 ISSN: 1873-2623 [Electronic] United States
• PMID: 25131120 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Bile Acids and Salts
• Selenium Radioisotopes
• Taurocholic Acid
• 23-seleno-25-homotaurocholic acid

Topics

• Adult
• Bile Acids and Salts
• Cholestasis, Intrahepatic (surgery)
• Humans
• Ileum (diagnostic imaging, physiopathology, transplantation)
• Male
• Pilot Projects
• Radionuclide Imaging
• Selenium Radioisotopes
• Taurocholic Acid (analogs & derivatives)
• Transplant Recipients