Pre-Transplant Serum FTIRS Signatures as Predictive Biomarkers of Early Transient Pancreatic Graft Dysfunction in Simultaneous Pancreas-Kidney Transplantation.

BACKGROUND/

OBJECTIVES

Early transient endocrine dysfunction after simultaneous pancreas-kidney transplantation (SPK) frequently triggers urgent investigations to exclude thrombosis, pancreatitis, or rejection, yet many recipients recover during the index admission. We tested whether pre-transplant day zero (D0) serum Fourier-transform infrared spectroscopy (FTIRS) captures a biochemical fingerprint associated with a Start&Stop trajectory (initial insulin independence followed by transient dysfunction with recovery).

METHODS

In a single-center retrospective case-control study nested within 104 consecutive SPK recipients with available D0 serum, 12 Start&Stop cases were matched 1:1 to 12 No-Stop controls. Serum FTIR spectra went through structured quality control and standardized preprocessing. A Naïve Bayes classifier with Fast Correlation-Based Filter (FCBF) feature selection was evaluated using leave-one-out cross-validation (LOOCV) and label-permutation analysis.

RESULTS

Under LOOCV, the primary FTIRS model (Savitzky-Golay second derivative; 600-900 and 2800-3400 cm-1) achieved excellent discrimination (ROC-AUC 1.00) with accuracy 0.958 and F1 score 0.958. Discrimination collapsed under label permutation (ROC-AUC 0.461), supporting a non-random label-spectrum association. Discriminant information mapped mainly to carbohydrate/glycoprotein-associated bands (~946-1161 cm-1), protein structural contributions near the amide III region (~1300 cm-1), and lipid/protein stretching modes (~2865-3163 cm-1), consistent with a multicomponent systemic biochemical state.

CONCLUSIONS

In this exploratory matched case-control cohort, pre-transplant D0 serum FTIRS signatures were associated with the subsequent Start&Stop phenotype after SPK. These findings should be interpreted as recipient-side exploratory risk-stratification signals rather than clinically actionable decision tools. Larger multicenter validation in unselected cohorts, with standardized endpoint adjudication, preanalytical control, fully nested model development and inter-instrument harmonization, is required before clinical implementation or population-level risk calibration.