Postoperative CRP and Serum Amylase Levels Predict Early Pancreas Graft Survival in Simultaneous Pancreas-Kidney Transplantation.

Abstract

Aim: The impact of ischemia-reperfusion (IR) injury on pancreatic graft survival after simultaneous pancreas-kidney (SPK) transplantation remains unknown. We investigated the role of early postoperative CRP and serum amylase (AMS) levels in predicting 1-year pancreas survival in our cohort of SPK recipients. Methods: CRP and serum AMS levels on postoperative days (POD) 1 to 3 were correlated to 1-year pancreatic graft survival. We defined the optimal cut-off levels by ROC curve analysis and explored the differences in survival between low/high CRP and AMS groups. Univariate and multivariate analysis were performed for the detection of significant predictors of pancreatic graft survival. Results: 277 SPKs performed between 1996 - 2013, were analyzed. Higher CRP (p=0.04) and AMS (p=0.002) levels on POD3 were associated with poorer graft survival at 1-year. A similar pattern was noted for CRP and AMS levels on POD2. Using optimal cut-off levels for both parameters, a significantly increased graft survival was shown for recipients with low CRP and low AMS compared to the groups with high levels, on both POD2 (p=0.03 and p=0.005, respectively) and POD3 (p=0.005 and p<0.001, respectively). Additionally, a rate of serum AMS decline greater than 51.8% from POD1 to POD3 was associated with better graft survival (p=0.015). In multivariate analysis, serum AMS on POD3 emerged as a significant predictor of graft survival at 1-year (OR 5.67, 95% CI 1.04-30.92), with a cut-off value of 129.5 IU/L. Conclusion: Our results suggest that high early postoperative CRP and serum AMS levels are associated with poorer pancreatic graft survival at 1-year after SPK transplant. These findings may prove useful in monitoring the effect of protective strategies against IR injury of the pancreatic graft.