title: Improving monitoring after pancreas transplantation alone: fine-tuning of an old technique.
abstract: Graft survival after pancreas transplantation alone (PTA) is significantly poorer than graft survival after simultaneous pancreas kidney (SPK) and is particularly affected by difficulty in monitoring rejection. Exocrine bladder drainage allows assessment of pancreas graft function as urinary amylase (UA). However, standards for UA collection and interpretation are not well defined. In this study, 21 bladder-drained PTA recipients were monitored with daily values for UA and urine creatinine (Creat) concentration from post-transplant 10-mL samples and 24-h collections. Clinical events were documented and correlated to UA measurements. UA values were found to increase post-transplant until day 15, and large interpatient variability was noted (median 12 676 IU/L, range 668-60 369 IU/L). A strong correlation was found total 24-h UA production and spot UA/Creat ratio (r = 0.80, p < 0.001). UA/Creat ratio showed less variation during episodes of impaired renal function; therefore, urinary amylase baseline was defined as the median UA/Creat ratio after day 15. A > 25% decrease of UA predicted 9/13 (69%) events. We conclude that individual baselines should be set once the values have stabilized after 15 d post-transplant and that spot UA/Creat measures are reliable, patient friendly and indicate potential events after PTA.
authors.affiliation: Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: Michiel D
authors.initials: MD
authors.lastname: Voskuil
authors.forename: Shruti
authors.initials: S
authors.lastname: Mittal
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Sharples
authors.forename: Anil
authors.initials: A
authors.lastname: Vaidya
authors.forename: James
authors.initials: J
authors.lastname: Gilbert
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Friend
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Ploeg
mesh_terms: D000328:Adult; D000681:Amylases / Q000652:urine*; D015415:Biomarkers / Q000652:urine*; D003404:Creatinine / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000652:urine*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D016035:Pancreas Transplantation; D010182:Pancreatic Diseases / Q000601:surgery / Q000652:urine*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine; D000681:Amylases
keywords: bladder-drained; isolated pancreas transplantation; urinary amylase