{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:10:16Z","timestamp":1778217016636,"version":"3.51.4"},"reference-count":39,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Objectives: Ischemia\u2013reperfusion injury (IRI) contributes to graft dysfunction in solid organ transplantation, with the pancreas vulnerable due to its fragile vasculature. Endothelial glycocalyx (eGCX) disruption is central to this process. This study prospectively examined perioperative endothelial injury in pancreas transplantation. Methods: Fifty-two recipients were included, of whom 47 underwent simultaneous pancreas-kidney (SPK) transplantation and 5 pancreas retransplantation. Biomarkers of eGCX degradation (syndecan-1, heparan sulfate (HS) and hyaluronan) and endothelial injury (soluble thrombomodulin, VEGF and soluble VEGFR1) were measured in plasma preoperatively, 10 min after pancreas reperfusion, 24 h later, and at discharge. Associations with donor type and early post-transplant outcomes were explored. Results: A marker endothelial injury was evident within 10 min of pancreas reperfusion, before kidney implantation, characterized by increased syndecan-1, HS, and sVEGFR1, together with decreased VEGF. Hyaluronan peaked at 24 h, consistent with a broader systemic endothelial response. Controlled donation after circulatory death donors showed higher syndecan-1 levels at 10 min PR and higher VEGF at 24 h. Seven recipients developed pancreas graft loss, which was linked to lower VEGF at 10 min post-reperfusion and lower hyaluronan levels both before surgery and at discharge. Kidney acute tubular necrosis was related with higher preoperative HS and elevated 24 h sVEGFR1. Among recipients with functioning grafts, preoperative endothelial biomarkers were linked to postoperative complications. Conclusions: Pancreas transplantation triggers early endothelial injury and glycocalyx shedding, particularly in a predominant SPK setting. Perioperative endothelial biomarkers may have a value for early risk stratification after transplantation.<\/jats:p>","DOI":"10.3390\/medsci14020241","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:03:37Z","timestamp":1778144617000},"page":"241","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Endothelial Injury in Pancreas Transplantation: Insights from a Prospective Cohort Largely Composed of Simultaneous Pancreas-Kidney Recipients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5723-4209","authenticated-orcid":false,"given":"Joana","family":"Ferrer-F\u00e0brega","sequence":"first","affiliation":[{"name":"Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Cl\u00ednic of Digestive and Metabolic Diseases (ICMDiM), Hospital Cl\u00ednic, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Network for Biomedical Research in Hepatic and Digestive Diseases (CIBEREHD), 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Llaves-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Experimental Pathology, Instituto de Investigaciones Biom\u00e9dicas de Barcelona (IIBB), Consejo Superior de Investigaciones Cient\u00edficas CSIC, 08036 Barcelona, Spain"},{"name":"Doctoral Program in Biomedicine, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8345-4598","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Rull","sequence":"additional","affiliation":[{"name":"Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Cl\u00ednic of Digestive and Metabolic Diseases (ICMDiM), Hospital Cl\u00ednic, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3536-4288","authenticated-orcid":false,"given":"\u00c1ngeles","family":"Garc\u00eda-Criado","sequence":"additional","affiliation":[{"name":"Network for Biomedical Research in Hepatic and Digestive Diseases (CIBEREHD), 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Department of Radiology, Hospital Cl\u00ednic, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-7503","authenticated-orcid":false,"given":"Pedro","family":"Ventura-Aguiar","sequence":"additional","affiliation":[{"name":"Network for Biomedical Research in Hepatic and Digestive Diseases (CIBEREHD), 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Cl\u00ednic, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roc\u00edo","family":"Garc\u00eda-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Cl\u00ednic of Digestive and Metabolic Diseases (ICMDiM), Hospital Cl\u00ednic, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6861-6982","authenticated-orcid":false,"given":"Mart\u00ed","family":"Manyalich-Blasi","sequence":"additional","affiliation":[{"name":"Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9237-0903","authenticated-orcid":false,"given":"Antonio J.","family":"Amor","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Cl\u00ednic, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0716-8784","authenticated-orcid":false,"given":"Jos\u00e9","family":"R\u00edos","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Department of Clinical Pharmacology, Hospital Clinic and Medical Statistics Core Facility, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Biostatistics Unit, School of Medicine, Universitat Aut\u00f2noma de Barcelona, 08193 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6199-3016","authenticated-orcid":false,"given":"Fritz","family":"Diekmann","sequence":"additional","affiliation":[{"name":"Network for Biomedical Research in Hepatic and Digestive Diseases (CIBEREHD), 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Renal Transplant Unit, Nephrology and Kidney Transplant Department, Hospital Cl\u00ednic, Universitat de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josep","family":"Fuster","sequence":"additional","affiliation":[{"name":"Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Institute Cl\u00ednic of Digestive and Metabolic Diseases (ICMDiM), Hospital Cl\u00ednic, Universitat de Barcelona, 08036 Barcelona, Spain"},{"name":"Network for Biomedical Research in Hepatic and Digestive Diseases (CIBEREHD), 08036 Barcelona, Spain"},{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6277-9027","authenticated-orcid":false,"given":"Emma","family":"Folch-Puy","sequence":"additional","affiliation":[{"name":"Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain"},{"name":"Department of Experimental Pathology, Instituto de Investigaciones Biom\u00e9dicas de Barcelona (IIBB), Consejo Superior de Investigaciones Cient\u00edficas CSIC, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2025, November 19). 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