Peritransplant pancreatitis: A marker of high mortality and graft failure in liver transplant patients

Abstract

Perioperative pancreatitis is a significant comorbid condition in surgical patients. However, the degree to which pancreatitis affects graft and overall survival in liver transplant recipients has not been evaluated. This study assesses the impact of pancreatitis on graft and patient survival in adult orthotopic liver transplantation (OLT). All patients undergoing OLT at a single academic institution from 2007 to 2015 were reviewed. Pancreatitis was classified by method of diagnosis (intraoperative/radiographic [IO/R] versus isolated serologic diagnosis) and timing (preoperative versus postoperative diagnosis). Twenty-three patients were identified with peritransplant pancreatitis (within 30 days preoperatively or postoperatively). A control group of patients without pancreatitis undergoing OLT was composed of 775 patients. Graft failure/death rates for patients with versus without pancreatitis were 7.4% versus 7.4% at 30 days, 33.3% versus 12.6% at 90 days, and 44.4% versus 26.9% at 12 months. Four patients with pancreatitis (17.4%) required emergent retransplantation and subsequently died within 90 days of their second transplant. Overall, 6 patients with pancreatitis (26.1%) died within 90 days of transplantation. Patients with pancreatitis had a hazard ratio (HR) for death or graft failure of 2.28 as compared with controls (P < 0.01). The effect of pancreatitis is most pronounced among those diagnosed by IO/R findings, with an adjusted HR of 2.53 (P < 0.01) and those diagnosed in the postoperative period, adjusted HR of 2.57 (P = 0.01). In conclusion, perioperative pancreatitis is associated with early graft failure and patient mortality, regardless of the method or timing of the diagnosis. Given these results, IO/R findings of pancreatitis should induce caution and potentially preclude OLT until resolved. Liver Transplantation 23 925-932 2017 AASLD.

Pancreatitis in Solid Organ Transplant Patients: A Review of the Literature

“…Regardless of the etiology of acute pancreatitis, it is associated with increased graft failure as well as increased morbidity and mortality in the liver transplant population [54,58]. In a study previously conducted at our institution, there was no difference in graft failure or death rates (7% vs. 7%) at 30days post-transplant in patients with peri-transplant pancreatitis (defined as 30 days pre-or posttransplant) when compared to controls.…”

“…However, graft failure or death rates were significantly higher in the acute pancreatitis group at both 60-and 90-days post-transplant (33% vs. 13% and 44% vs. 27%, respectively). The overall hazard ratio (HR) for graft failure or death in the acute pancreatitis group compared to controls was 2.28 (p < 0.01), and the HR in the post-transplant acute pancreatitis group was slightly higher at 2.57 (p < 0.01) [58].…”

Acute Pancreatitis in Patients After Liver Transplantation

“…The reported incidence of acute pancreatitis in liver transplant recipients is 1.5–8% [ 14 – 16 ]. A higher risk is associated with hepatitis B infection as an indication for transplantation [ 17 ], retransplantation, extent of pancreatic dissection, type of biliary reconstruction, duration of venous bypass (>90 min), quantity of intraoperative i.v.…”

“…Mortality due to AP in transplant recipients is typically greater than in the general population, reaching up to 63.6% [ 14 – 16 , 19 ]. Higher mortality was reported in a group of patients with early pancreatitis (within 30 days of transplantation) and in individuals with a history of pancreatitis during the pre-transplant period.…”

“…Higher mortality was reported in a group of patients with early pancreatitis (within 30 days of transplantation) and in individuals with a history of pancreatitis during the pre-transplant period. The presence of pancreatitis has also been strongly associated with a higher risk of graft failure [ 16 ].…”