*Purpose: An increase in the serum concentration of pancreatic enzymes (amylase and lipase) is commonly related to an acute inflammatory process in the pancreas graft among pancreas transplant recipients (PTRs). The association between immediate post-operative increases in pancreatic enzymes and long-term post-transplant graft and patient outcomes is unknown.

*Methods: We analyzed all PTRs transplanted at our hospital between 06/2009 and 09/2018. Due to changes in the normal laboratory values for amylase (A) and lipase (L) during the study period, enzyme levels were presented as a ratio of absolute numbers to the upper limit of normal value, with value > 1 considered as abnormal. We specifically evaluated patient and graft survival based on the amylase or lipase ratios on day 1 (A1, L1) and maximum ratios within 5 days of transplant (Amax, Lmax). We also evaluated outcomes after excluding grafts that failed within 90 days of transplant.

*Results: There were a total of 443 PTRs during the study period, 287 were simultaneous pancreas and kidney (SPK) recipients, and 156 solitary pancreas recipients (SP). There was a total of 102 pancreas graft failures,yet an early rise in enzymes was not associated with pancreas graft failure: A1 (HR: 1.02, 95% CI: 0.97-1.06, p=0.45); Amax (HR: 1.02, 95% CI: 0.97-1.06, p=0.46); L1 (HR: 1.0, 95% CI: 0.96-1.04, p=0.99); Lmax (HR: 1.01, 95% CI: 0.97-1.04,p=0.72). There were 46 deaths during the study period. High immediate post-transplant pancreatic enzyme levels were not associated with patient mortality: A1 (HR: 1.05, 95% CI: 0.99-1.10, p=0.08); Amax (HR: 1.05, 95% CI: 0.99-1.10, p=0.09); L1 (HR: 1.02, 95% CI: 0.98-1.06, p=0.24); Lmax (HR: 1.03, 95% CI: 0.99-1.06, p=0.07). Similarly, there were 117 PTRs with biopsy-proven pancreas rejection, and similarly, no association with early post-transplant enzyme increases was observed. Similar findings were seen when considering SPK only or SP only in separate analyses, or after excluding grafts that failed within 90 days of transplant thereby focusing on non-technical failures, or including outcomes only 1-year post transplant. Finally, we failed to reveal an association between immediate post-transplant enzyme increases with long-term functional graft outcomes as measured by C-peptide or HbA1c.

*Conclusions: In this large series of PTRs, immediate post-transplant increases in pancreatic enzymes, reflecting early graft pancreatitis, possibly due to ischemia reperfusion injury, was not associated with patient survival, pancreas graft survival, rejection, or long term endocrine graft function. More studies in this field are needed.

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