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Improving monitoring after pancreas transplantation alone: fine‐tuning of an old technique
Author(s) -
Voskuil Michiel D.,
Mittal Shruti,
Sharples Edward J.,
Vaidya Anil,
Gilbert James,
Friend Peter J.,
Ploeg Rutger J.
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12416
Subject(s) - medicine , transplantation , urology , urinary system , creatinine , amylase , pancreas transplantation , pancreas , renal function , urine , kidney transplantation , kidney , surgery , gastroenterology , enzyme , biochemistry , chemistry
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 .