High Urine Amylase Level and the Risk of Enteric Conversion in Solitary Pancreas Transplant Recipients
Abstract Introduction Compared with enteric drainage, bladder-drained solitary pancreas transplants can be monitored for rejection by measuring urine amylase levels. However, bladder drainage is associated with a higher risk of infection and metabolic complications, necessitating enteric conversion...
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Published in | Transplantation proceedings Vol. 46; no. 6; pp. 1938 - 1941 |
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Language | English |
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Abstract | Abstract Introduction Compared with enteric drainage, bladder-drained solitary pancreas transplants can be monitored for rejection by measuring urine amylase levels. However, bladder drainage is associated with a higher risk of infection and metabolic complications, necessitating enteric conversion in about one third of patients. We hypothesized that hypersecreting pancreata with high urine amylase levels have a higher propensity for enteric conversion from an antecedent elevated enzymatic effect on the urinary tract and increased fluid losses. Patients and Methods We analyzed the risk for enteric conversion in 312 bladder-drained solitary pancreas transplant recipients. Urine amylase levels at 30 days were used to identify those at risk for enteric conversion. Time-to-event analysis was used to evaluate the risk of enteric conversion at 10 years, adjusting for urine amylase level and other confounding factors. Confounding risk factors statistically related to enteric conversion were incorporated into the multivariable analysis by using Cox proportional hazards regression at 3 years' posttransplant. Results During the median follow-up of 184.6 months, 31% of recipients underwent duct conversion. A majority of recipients (84.5%) who required duct conversion were primary transplants. The 30-day median urine amylase level was 1749 IU/h (quartile 1, <777 IU/h; quartile 3, ≥3272 IU/h). Using receiver operating characteristic analysis, it was determined that urine amylase levels >3272 IU/h had the greatest specificity for predicting risk of enteric conversion. In the multivariate analysis, high urine amylase levels increased the risk of enteric conversion only in repeated pancreas transplants. Conclusions Primary transplants are more likely to undergo enteric conversion than retransplants. High urine amylase levels increase the risk of enteric conversion in retransplants only, and therefore this enzyme alone cannot serve as the sole predictor for conversion in primary transplants. Other factors, such as fluid and bicarbonate losses, increased bladder pressure, and a pre-existing lower urinary tract pathologic condition may be also responsible for the development of complications; these factors warrant additional study. |
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AbstractList | Compared with enteric drainage, bladder-drained solitary pancreas transplants can be monitored for rejection by measuring urine amylase levels. However, bladder drainage is associated with a higher risk of infection and metabolic complications, necessitating enteric conversion in about one third of patients. We hypothesized that hypersecreting pancreata with high urine amylase levels have a higher propensity for enteric conversion from an antecedent elevated enzymatic effect on the urinary tract and increased fluid losses.
We analyzed the risk for enteric conversion in 312 bladder-drained solitary pancreas transplant recipients. Urine amylase levels at 30 days were used to identify those at risk for enteric conversion. Time-to-event analysis was used to evaluate the risk of enteric conversion at 10 years, adjusting for urine amylase level and other confounding factors. Confounding risk factors statistically related to enteric conversion were incorporated into the multivariable analysis by using Cox proportional hazards regression at 3 years' posttransplant.
During the median follow-up of 184.6 months, 31% of recipients underwent duct conversion. A majority of recipients (84.5%) who required duct conversion were primary transplants. The 30-day median urine amylase level was 1749 IU/h (quartile 1, <777 IU/h; quartile 3, ≥3272 IU/h). Using receiver operating characteristic analysis, it was determined that urine amylase levels >3272 IU/h had the greatest specificity for predicting risk of enteric conversion. In the multivariate analysis, high urine amylase levels increased the risk of enteric conversion only in repeated pancreas transplants.
Primary transplants are more likely to undergo enteric conversion than retransplants. High urine amylase levels increase the risk of enteric conversion in retransplants only, and therefore this enzyme alone cannot serve as the sole predictor for conversion in primary transplants. Other factors, such as fluid and bicarbonate losses, increased bladder pressure, and a pre-existing lower urinary tract pathologic condition may be also responsible for the development of complications; these factors warrant additional study. Abstract Introduction Compared with enteric drainage, bladder-drained solitary pancreas transplants can be monitored for rejection by measuring urine amylase levels. However, bladder drainage is associated with a higher risk of infection and metabolic complications, necessitating enteric conversion in about one third of patients. We hypothesized that hypersecreting pancreata with high urine amylase levels have a higher propensity for enteric conversion from an antecedent elevated enzymatic effect on the urinary tract and increased fluid losses. Patients and Methods We analyzed the risk for enteric conversion in 312 bladder-drained solitary pancreas transplant recipients. Urine amylase levels at 30 days were used to identify those at risk for enteric conversion. Time-to-event analysis was used to evaluate the risk of enteric conversion at 10 years, adjusting for urine amylase level and other confounding factors. Confounding risk factors statistically related to enteric conversion were incorporated into the multivariable analysis by using Cox proportional hazards regression at 3 years' posttransplant. Results During the median follow-up of 184.6 months, 31% of recipients underwent duct conversion. A majority of recipients (84.5%) who required duct conversion were primary transplants. The 30-day median urine amylase level was 1749 IU/h (quartile 1, <777 IU/h; quartile 3, ≥3272 IU/h). Using receiver operating characteristic analysis, it was determined that urine amylase levels >3272 IU/h had the greatest specificity for predicting risk of enteric conversion. In the multivariate analysis, high urine amylase levels increased the risk of enteric conversion only in repeated pancreas transplants. Conclusions Primary transplants are more likely to undergo enteric conversion than retransplants. High urine amylase levels increase the risk of enteric conversion in retransplants only, and therefore this enzyme alone cannot serve as the sole predictor for conversion in primary transplants. Other factors, such as fluid and bicarbonate losses, increased bladder pressure, and a pre-existing lower urinary tract pathologic condition may be also responsible for the development of complications; these factors warrant additional study. |
Author | Kukla, A Kandaswamy, R Radosevich, D.M Finger, E.B |
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Cites_doi | 10.1097/SLA.0b013e3181b76d2b 10.1111/j.1399-0012.2005.00477.x 10.1097/TP.0b013e31816361f7 10.1152/ajpregu.00129.2012 10.1111/ajt.12269 10.1111/j.1399-0012.2010.01363.x 10.1900/RDS.2011.8.6 10.1034/j.1399-0012.2003.02026.x |
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References | van de Linde, van der Boog, Baranski, de Fijter, Ringers, Schaapherder (bib4) 2006; 20 Hanna-Mitchell, Ruiz, Daneshgari, Liu, Apodaca, Birder (bib7) 2013; 304 Finger, Radosevich, Dunn (bib3) 2013; 13 Sollinger, Odorico, Becker, D'Alessandro, Pirsch (bib2) 2009; 250 Kleespies, Mikhailov, Khalil (bib6) 2011; 25 Marang-van de Mheen, Nijhof, Khairoun, Haasnoot, van der Boog, Baranski (bib5) 2008; 85 Gruessner (bib1) 2011; 8 Blanchet, Droupy, Eschwege (bib8) 2003; 17 Marang-van de Mheen (10.1016/j.transproceed.2014.05.081_bib5) 2008; 85 Sollinger (10.1016/j.transproceed.2014.05.081_bib2) 2009; 250 Kleespies (10.1016/j.transproceed.2014.05.081_bib6) 2011; 25 Gruessner (10.1016/j.transproceed.2014.05.081_bib1) 2011; 8 Finger (10.1016/j.transproceed.2014.05.081_bib3) 2013; 13 Hanna-Mitchell (10.1016/j.transproceed.2014.05.081_bib7) 2013; 304 van de Linde (10.1016/j.transproceed.2014.05.081_bib4) 2006; 20 Blanchet (10.1016/j.transproceed.2014.05.081_bib8) 2003; 17 |
References_xml | – volume: 20 start-page: 253 year: 2006 end-page: 257 ident: bib4 article-title: Pancreas transplantation: advantages of both enteric and bladder drainage combined in a two-step approach publication-title: Clin Transplant contributor: fullname: Schaapherder – volume: 8 start-page: 6 year: 2011 end-page: 16 ident: bib1 article-title: 2011 Update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR) publication-title: Rev Diabet Stud contributor: fullname: Gruessner – volume: 17 start-page: 26 year: 2003 end-page: 31 ident: bib8 article-title: Urodynamic testing predicts long-term urological complications following simultaneous pancreas-kidney transplantation publication-title: Clin Transplant contributor: fullname: Eschwege – volume: 25 start-page: 549 year: 2011 end-page: 560 ident: bib6 article-title: Enteric conversion after pancreatic transplantation: resolution of symptoms and long-term results publication-title: Clin Transplant contributor: fullname: Khalil – volume: 304 start-page: R84 year: 2013 end-page: 93 ident: bib7 article-title: Impact of diabetes mellitus on bladder uroepithelial cells publication-title: Am J Physiol Regul Integr Comp Physiol contributor: fullname: Birder – volume: 13 start-page: 1840 year: 2013 end-page: 1849 ident: bib3 article-title: A composite risk model for predicting technical failure in pancreas transplantation publication-title: Am J Transplant contributor: fullname: Dunn – volume: 85 start-page: 517 year: 2008 end-page: 523 ident: bib5 article-title: Pancreas-kidney transplantations with primary bladder drainage followed by enteric conversion: graft survival and outcomes publication-title: Transplantation contributor: fullname: Baranski – volume: 250 start-page: 618 year: 2009 end-page: 630 ident: bib2 article-title: One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up publication-title: Ann Surg contributor: fullname: Pirsch – volume: 250 start-page: 618 year: 2009 ident: 10.1016/j.transproceed.2014.05.081_bib2 article-title: One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up publication-title: Ann Surg doi: 10.1097/SLA.0b013e3181b76d2b contributor: fullname: Sollinger – volume: 20 start-page: 253 year: 2006 ident: 10.1016/j.transproceed.2014.05.081_bib4 article-title: Pancreas transplantation: advantages of both enteric and bladder drainage combined in a two-step approach publication-title: Clin Transplant doi: 10.1111/j.1399-0012.2005.00477.x contributor: fullname: van de Linde – volume: 85 start-page: 517 year: 2008 ident: 10.1016/j.transproceed.2014.05.081_bib5 article-title: Pancreas-kidney transplantations with primary bladder drainage followed by enteric conversion: graft survival and outcomes publication-title: Transplantation doi: 10.1097/TP.0b013e31816361f7 contributor: fullname: Marang-van de Mheen – volume: 304 start-page: R84 year: 2013 ident: 10.1016/j.transproceed.2014.05.081_bib7 article-title: Impact of diabetes mellitus on bladder uroepithelial cells publication-title: Am J Physiol Regul Integr Comp Physiol doi: 10.1152/ajpregu.00129.2012 contributor: fullname: Hanna-Mitchell – volume: 13 start-page: 1840 year: 2013 ident: 10.1016/j.transproceed.2014.05.081_bib3 article-title: A composite risk model for predicting technical failure in pancreas transplantation publication-title: Am J Transplant doi: 10.1111/ajt.12269 contributor: fullname: Finger – volume: 25 start-page: 549 year: 2011 ident: 10.1016/j.transproceed.2014.05.081_bib6 article-title: Enteric conversion after pancreatic transplantation: resolution of symptoms and long-term results publication-title: Clin Transplant doi: 10.1111/j.1399-0012.2010.01363.x contributor: fullname: Kleespies – volume: 8 start-page: 6 year: 2011 ident: 10.1016/j.transproceed.2014.05.081_bib1 article-title: 2011 Update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed up over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR) publication-title: Rev Diabet Stud doi: 10.1900/RDS.2011.8.6 contributor: fullname: Gruessner – volume: 17 start-page: 26 year: 2003 ident: 10.1016/j.transproceed.2014.05.081_bib8 article-title: Urodynamic testing predicts long-term urological complications following simultaneous pancreas-kidney transplantation publication-title: Clin Transplant doi: 10.1034/j.1399-0012.2003.02026.x contributor: fullname: Blanchet |
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Snippet | Abstract Introduction Compared with enteric drainage, bladder-drained solitary pancreas transplants can be monitored for rejection by measuring urine amylase... Compared with enteric drainage, bladder-drained solitary pancreas transplants can be monitored for rejection by measuring urine amylase levels. However,... |
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SubjectTerms | Adult Aged Amylases - urine Anastomosis, Surgical Duodenum - surgery Female Follow-Up Studies Humans Jejunum - surgery Male Middle Aged Pancreas - secretion Pancreas Transplantation Postoperative Complications - surgery Proportional Hazards Models Retrospective Studies Surgery Transplant Recipients Urinary Bladder - surgery |
Title | High Urine Amylase Level and the Risk of Enteric Conversion in Solitary Pancreas Transplant Recipients |
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