*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 post-transplant complications is unknown.

*Methods: We analyzed all PTRs transplanted at our hospital between 06/2009 and 09/2018. Due to changes in laboratory assays 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 bleeding, fluid collections (including enteric leak, enzyme leak, pancreatic ascites etc), and thrombosis complications based on the amylase or lipase ratios on day 1 (A1, L1) and maximum ratios within 5 days of transplant (Amax, Lmax). PTRs with index complications that occurred before the date of enzyme determination were excluded. We focused on technical complications which occurred 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 were a total of 78 PTRs with complications of interest. Higher A1 (HR: 1.05, 95% CI: 1.02-1.09, p=0.004); Amax (HR: 1.06, 95% CI: 1.02-1.09, p <0.001); L1 (HR: 1.03, 95% CI: 1.01-1.05, p=0.009); Lmax (HR: 1.03, 95% CI: 1.01-1.05,p=0.002), were associated with an increase in early complications. Similar findings were seen when considering SPK only or SP only in separate analyses. When considering specific complications such as fluid collections, bleeding or thrombosis, we observed a significant association between higher immediate post-transplant enzyme increases and fluid collection complications, whereas we did not observe a similar association with bleeding, or partial or complete thrombosis complications.

*Conclusions: In this large series of PTRs, early increases in pancreatic enzymes was associated with early post-transplant surgical complications, especially post-operative fluid collections. This finding suggests cases of early perioperative enzyme increases merit consideration for early imaging investigation to mitigate detrimental outcomes.

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