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Day-Zero Serum FTIR Spectroscopy Identifies a Biochemical Signature Associated with Functional Pancreas Graft Dysfunction After Simultaneous Pancreas–Kidney Transplantation
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Resumo(s)
Background: Simultaneous pancreas–kidney (SPK) transplantation can restore renal function and insulin independence, but non-technical pancreas graft dysfunction remains difficult to anticipate. Methods: We conducted an exploratory single-centre retrospective biomarker-modelling study to determine whether day-zero recipient serum Fourier-transform infrared (FTIR) spectra are associated with subsequent loss of insulin independence after SPK transplantation. Results: Among 104 screened recipients, 51 met predefined sample-availability, spectral-quality, data-linkage and endpoint-adjudication criteria; 30 maintained pancreas graft function and 21 developed dysfunction. Cases dominated by early technical surgical failure were excluded. Clinical-only, FTIR-only and FTIR–clinical Naïve Bayes models were evaluated using leave-one-out cross-validation with Fast Correlation-Based Filter feature selection. In locked-feature internal validation, the best FTIR-only model used second-derivative spectra with vector normalization and nine selected wavenumbers, achieving AUC 0.997 (95% CI 0.985–1.000) and accuracy 0.961 (95% CI 0.902–1.000). A fixed-feature permutation analysis exceeded label-randomized performance (empirical p = 0.001). The secondary Group 1 versus Group 3 analysis suggested discrimination of pancreas dysfunction despite preserved kidney function (AUC 0.992; accuracy 0.930). Conclusions: Given the small cohort, high-dimensional input, non-nested feature selection, selection-bias risk and absence of external validation, serum FTIR should be considered a candidate risk-enrichment platform requiring prospective multicentre validation.
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Publisher Copyright: © 2026 by the authors.
Palavras-chave
FCBF FTIR spectroscopy leave-one-out cross-validation loss of insulin independence machine learning Naïve Bayes pancreas graft dysfunction risk stratification serum biomarker simultaneous pancreas–kidney transplantation spectral quality control Ecology, Evolution, Behavior and Systematics General Biochemistry,Genetics and Molecular Biology Space and Planetary Science Palaeontology