An elevated serum amylase level following pancreas-kidney transplantation may be due to:

A. Preservation/procurement injury.

B. Rejection. 

D. Duodenal segment leak or bladder leak.

E. Native pancreatitis.

F. Constipation. 

DISCUSSION: During the immediate postoperative period, an elevated serum amylase is usually due to preservation or procurement injury to the transplanted pancreas. If UW (University of Wisconsin) solution and a good flushout technique is used in an acceptable donor, amylase is usually elevated only several hundred points and will decline in a day or two. Rejection of the pancreas can also cause elevated serum amylase and is usually accompanied by a rise in the creatinine value due to concomitant renal transplant rejection. Reflux pancreatitis is generally caused by bladder dysfunction: increased pressure transmitted back through the pancreatic ducts causes pancreatitis. It is generally relieved by bladder decompression with a Foley catheter. Naturally, leakage from the anastomosis of the pancreas transplant to the bladder causes absorption of amylase from the peritoneal cavity and an elevated serum amylase value. Constipation causes a rise in the amylase level of pancreas-kidney transplant recipients, for reasons that remain unclear. Native pancreatitis has to be borne in mind in the differential diagnosis of hyperamylasemia in transplant patients. Contributing factors may include underlying gallbladder disease, as well as side effects of steroids and Imuran.