INTRODUCTION. Graft pancreatitis remains difficult to diagnose using clinical assessment alone, leading to indiscriminate use of cross-sectional imaging. We seek to correlate the presence of radiological features of graft pancreatitis to biochemical markers of inflammation and to clinical outcome.

METHODS. A retrospective analysis of 109 simultaneous pancreas-kidney transplants performed at our center between January 2005 and December 2010 was undertaken. All 299 post-operative CT scans performed on this cohort were blindly scored by 2 independent radiologists for features of pancreatitis – graft enlargement (normal=0; enlarged=1), graft perfusion (normal=0; heterogeneous =1), ascites (absent=0; present=1) and peri-pancreatic fat changes (mild=0; moderate=1; severe=2). CT score was correlated to the length of post-operative stay and to levels of candidate serum inflammatory markers measured within 24 hours of each scan.

RESULTS. A CT score ≥ 2 in the post-operative index admission correlated with a significant increase in median length of stay (26 vs. 19 days, p=0.044). Mean serum CRP levels were significantly higher in patients with positive CT findings (p<0.001) including enlarged vs. normal graft size (114±74 vs. 76±80 mg/L) heterogeneous vs. normal perfusion (132±81 vs. 82±76 mg/L), presence vs. absence of ascites (125±81 vs. 74±73 mg/L) and mild vs. moderate vs. severe peri-pancreatic fat changes (23±34 vs. 53±59 vs. 107±80 mg/L). Serum CRP correlated closely with the CT score (p<0.001), and the median length of stay was significantly longer (26 vs. 17 days, p=0.005) in patients with a CRP > 50. Mean serum white cell counts were also significantly higher in patients with enlarged grafts (10±5.1 vs. 8.7±5.5 x10⁹ cells/L, p=0.013) and CT-detectable ascites (11±5.2 vs. 8.7±5.6 x10⁹cells/L, p=0.006), and correlated linearly with the CT score (p<0.001). In contrast, serum amylase and lipase levels had no significant correlation with radiological grading of pancreatitis or effect on length of post-operative patient stay.

CONCLUSION. CRP and white cell count are useful markers of graft pancreatitis and as such may allow avoidance of repeated radiological investigations to assess graft inflammation.

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