Serum pancreatic enzymes in the early postoperative period predict complications associated with pancreatic fluid after pancreas transplantation: A retrospective, single‐center, observational cohort study

Tursunović

Bosn J of Basic Med Sci

et al. 2022

The association between urine amylase levels and the development of postoperative complications after Whipple resection is still unknown. Aim of this study was to determine the prognostic value of urine amylase levels for postoperative complications in patients who underwent Whipple resection. In this retrospective cohort study, we analyzed amylase levels in urine, serum and drains in 52 patients who underwent Whipple resection preoperatively and on Postoperative Day 1 (POD1) after the intervention. Patients were followed up for 3 months to assess their predictive value for postoperative complications. In patients with complications, urine amylase levels were significantly higher on POD1 than before resection (198.89 ± 28.41 vs. 53.70 ± 7.44, p=0.000). Considering the sensitivity and specificity of the urine amylase level on POD1, an area under the ROC curve of 0.918 was obtained (p<0.001, 95% CI: 0.894-0.942). Patients with urine amylase levels ³140.00 U/L had significantly higher risks of postoperative pancreatic fistula (POPF) grade C (definition of POPF done according to the ISGP) (RR:20.26; 95% CI: 1.18-347.07; p=0.038), readmission to hospital (RR: 6.61; 95% CI: 1.53-28.58; p=0.011), reoperation (RR: 5.67; 95% CI: 1.27-25.27; p=0.023), and mortality (RR:17.00; 95% CI: 2.33-123.80; p=0.005) than patients with urine amylase levels <140.00 U/L. Urine amylase levels on POD1 displayed strong and significant positive correlations with serum amylase levels (r=0.92, p=0.001) and amylase levels in drains (r=0.86, p=0.002). We can conclude that urine amylase levels on POD1 have good prognostic value for postoperative complications after Whipple resection and might be used as an additional predictive risk factor.

Section: Discussionsupporting

confidence: 87%

Urine amylase level after Whipple resection might be a predictive factor of postoperative complications

Tursunović

Bosn J of Basic Med Sci

et al. 2022

“…As noted previously by our group, hyperamylasemia after SPK on postoperative day 1 is a significant risk factor for subsequent morbidity [5]. This finding has been reproduced recently by another study [12], and recent findings have also demonstrated hyperamylasemia and postoperative pancreatitis to have clinical relevance after pancreatic resections [13,14]. Thus, drugs targeting pancreatic exocrine suppression-such as somatostatin-analogues-may offer a potential mitigation strategy for pancreas graft related complications after pancreas transplantation.…”

Section: Introductionsupporting

confidence: 80%

“…As no control group was available, it is difficult to assess the exocrine suppressive effect of these somatostatins. As noted in previous studies [ 5 , 12 ], early hyperamylasemia is a significant risk factor for subsequent morbidity after SPK, and interventions mitigating it—such as somatostatin-analogues—could be of interest [ 5 ]. Interestingly, c-peptide levels were significantly lower throughout the first 7 POD’s in the pasireotide group but leveled off during the 180-day follow up, and did not seem to associate with adverse events.…”

Section: Discussionmentioning

confidence: 99%

Pasireotide Versus Octreotide in Preventing Complications After Simultaneous Pancreas-Kidney Transplantation

Ahopelto

Bonsdorff

Räihä³

et al. 2023

Transpl Int

In elective pancreatic surgery, somatostatin-analogues pasireotide and octreotide are variably used to reduce postoperative complications, but knowledge on their role in pancreas transplantation is limited. This study compared pasireotide and octreotide for their association with complications after simultaneous pancreas-kidney transplantation (SPK). This retrospective study included consecutive patients undergoing SPK’s from July 2013 to July 2022. Between July 2013 and April 2020, octreotide was administered 0.1 mg s.c. once daily and between May 2020 and July 2022 pasireotide was administered 0.9 mg twice daily, both until third postoperative day. Complications within 90 days postoperatively were collected, and reoperation rate and Comprehensive Complication index (CCI) ≥ 33.7 (morbidity equal to one reoperation) were used as primary outcomes. Of the 213 patients undergoing SPK, 150 patients received octreotide and 63 pasireotide. Baseline characteristics were comparable. Reoperation rate was 25.3% (n = 38) and 17.5% (n = 11) (p = 0.213) and rate of CCI ≥ 33.7 was 40.7% (n = 61) and 30.2% (n = 19) (p = 0.148) in octreotide and pasireotide groups, respectively. When adjusted with donor BMI, pancreas donor risk index, and donor sex, receiving pasireotide translated into OR 0.49 (95% CI: 0.25–0.96 p = 0.037) for CCI ≥ 33.7. Pasireotide was independently associated with lower postoperative morbidity within 90 days of SPK compared to octreotide.

“…Furthermore, a recent study among SPK recipients suggested that elevated plasma amylase levels on postoperative day 1 were significantly correlated with increased incidence of pancreas graft-related complications, need for relaparotomy, and subsequent morbidity 20 . Finally, Tomihara et al 21 presented findings in a small cohort of 69 recipients suggesting an early rise in pancreatic enzymes and some of the complications that were previously reported. Taken together, these studies suggest a possible link between increased perioperative amylase levels and postoperative complications.…”

Section: Discussionmentioning

confidence: 87%

“…Taken together, these studies suggest a possible link between increased perioperative amylase levels and postoperative complications. However, the majority of these studies involved small cohorts, 17 evaluated only one enzyme (amylase), 17,20,22 evaluated only one complication type, 17,21 or only evaluated SPK transplants. 20 Thus, a more comprehensive evaluation of the association of perioperative enzyme elevations and outcomes was undertaken.…”

Section: Discussionmentioning

confidence: 99%

Early Increases in Posttransplant Pancreatic Enzymes Are Associated With Surgical Complications But Not Graft Failure Among Pancreas Transplant Recipients

Parajuli¹,

Leverson

Kaufman

et al. 2022

Pancreas

ObjectivesThis study aimed to find the association between immediate postoperative increases in pancreatic enzymes and posttransplant complications among pancreas transplant recipients (PTRs).MethodsWe analyzed all PTRs transplanted at the University of Wisconsin between June 2009 and September 2018. 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, and thrombosis complications based on the amylase or lipase ratios on day 1 (Amylase1, Lipase1) and maximum ratios within 5 days of transplant (Amylasemax, Lipasemax). For early complications, we focused on technical complications that occurred within 90 days of transplant. For long-term outcomes, we assessed patient and graft survival, and rejections.ResultsThere were a total of 443 PTRs, 287 were simultaneous pancreas and kidney recipients, and 156 were solitary pancreas recipients. Higher Amylase1, Liplase1, Amylasemax, and Lipasemax were associated with an increase in early complications, mainly need for pancreatectomy, fluid collections, bleeding complications, or graft thrombosis, particularly in the solitary pancreas group.ConclusionsOur finding suggests that cases of early perioperative enzyme increase merit consideration for early imaging investigation to mitigate detrimental outcomes.