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.
To cite this abstract in AMA style:Chhabra M, Powell F, Hillard N, Bradley J, Watson C, Shaw A, Pettigrew G, Harper S. Utility of Serum Markers in Evaluating Graft Pancreatitis Following Simultaneous Pancreas-Kidney Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/utility-of-serum-markers-in-evaluating-graft-pancreatitis-following-simultaneous-pancreas-kidney-transplantation/. Accessed October 30, 2020.
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