Acute pancreatitis after cardiac transplantation

Adiseshiah, M; Wells, Francis C.; Cory-Pearce, R.; Wallwork, J.; English, T. A. H.

doi:10.1007/bf01655943

Cited by 19 publications

(5 citation statements)

References 9 publications

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“…80 Many other studies have observed a high incidence of AP and a much higher incidence of death compared with AP from other causes. 86 Liver Transplant AP has also been reported following liver transplantation. 78,84 Colon et al reported an incidence and mortality of 18.6% and 40%, respectively, in 86 patients who underwent cardiac transplantation.…”

Section: Renal Transplantmentioning

confidence: 96%

Factors Influencing Mortality in Acute Pancreatitis

Pitchumoni

Patel²,

Shah³

2005

Journal of Clinical Gastroenterology

101

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Severe acture pancreatitis (SAP), a multisystem disease, is characterized by multiple organ system failure and additionally by local pancreatic complications such as necrosis, abscess, or pseudocyst. The rate of mortality in SAP, which is about 20% of all cases of acute pancreatitis (AP), may be as high as 25%, as in infected pancreatic necrosis. The factors that influence mortality in different degrees are various. Etiology for the episode, age, sex, race, ethnicity, genetic makeup, severity on admission, and the extent and nature of pancreatic necrosis (sterile vs. infected) influence the mortality. Other factors include treatment modalities such as administration of prophylactic antibiotics, the mode of feeding (TPN vs. enteral), ERCP with sphincterotomy, and surgery in selected cases. Epidemiological studies indicate that the incidence of AP is increasing along with an increase in obesity, a bad prognostic factor. Many studies have indicated a worse prognosis in idiopathic AP compared to pancreatitis induced by alcoholism or biliary stone. The risk for SAP after ERCP is the subject of extensive study. AP after trauma, organ transplant, or coronary artery bypass surgery is rare but may be serious. Since Ranson reported early prognostic criteria, a number of attempts have been made to simplify or add new clinical or laboratory studies in the early assessment of severity. Obesity, hemoconcentration on admission, presence of pleural effusion, increased fasting blood sugar, as well as creatinine, elevated CRP in serum, and urinary trypsinogen levels are some of the well-documented factors in the literature. The role of appropriate prophylactic antibiotic therapy although still is highly controversial, in properly chosen cases appears to be beneficial and well accepted in clinical practice. Early enteral nutrition has gained much support and jejunal feeding bypassing the pancreatic stimulatory effect of it in the duodenum is desirable in selected cases. The limited role for endoscopic sphincterotomy in patients with demonstrated dilated CBD with impacted stone and evidence of impending cholangitis is well documented. Surgery in AP other than for removal of the gallbladder is often limited to infected pancreatic necrosis, pseudocysts, and pancreatic abscess and in some cases of traumatic pancreatitis with a ruptured duct system. The progress in the understanding of the role of cytokines will over us opportunities to use immunomodulatory therapies to improve the outcome in SAP.

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Section: Renal Transplantmentioning

confidence: 96%

Factors Influencing Mortality in Acute Pancreatitis

Pitchumoni

Patel²,

Shah³

2005

Journal of Clinical Gastroenterology

101

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“…Cardiopulmonary bypass and cardiac transplantation have been associated with pancreatitis. 205,206 Systemic hypotension leading to hypoperfusion as well as atheromatous emboli to the pancreatic circulation appears to be the mechanism in such cases. High doses of calcium in the perioperative period have also been implicated in pancreatitis following cardiopulmonary bypass.…”

Section: Iatrogenic Pancreatitismentioning

confidence: 99%

Acute Pancreatitis: Bench to the Bedside

et al. 2007

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“…Pancreatitis has been described as an important complication of renal and cardiac transplantation. [1][2][3][4][11][12][13][14][15]17,18 In the azathioprine era of renal transplantation, acute pancreatitis has been reported to be associated with a mortality rate of 50%. The pathogenesis of steroid-related pancreatitis is unclear; however, a mechanism of vascular occlusion similar to avascular necrosis of bones in the presence of chronic steroid therapy has been suggested.…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of steroid-related pancreatitis is unclear; however, a mechanism of vascular occlusion similar to avascular necrosis of bones in the presence of chronic steroid therapy has been suggested. 1,2,[10][11][12][13][14][15] The proposed etiologies of pancreatitis in transplant patients are numerous: cyclosporine, azathioprine, prednisolone, cytomegalovirus (CMV) infection, and cardiopulmonary bypass with a prolonged bypass time and a low flow state have been implicated. 4,5,7,12 Still, hardly a single report can be found on chronic pancreatitis emerging after renal or cardiac transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][6][7][8]12 This frequency is 15-25 times higher than after other cardiac procedures. 15,16 Moreover, due to its crypto-symptomatic course, pancreatitis is often not adequately diagnosed and therefore tends to be inappropriately treated, and thus it is not uncommonly reported as an unsuspected finding or cause of death at autopsy 1,2,12 in this group of patients.…”

Section: Introductionmentioning

confidence: 97%

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Pancreatitis Following Heart Transplantation: Report of a Case

et al. 2003

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Serious complications involving the alimentary tract following cardiac transplantations are commonly reported, and may be associated with significant morbidity and mortality. One of the most serious gastrointestinal complications in such patients is acute pancreatitis. There is still little known concerning its pathogenesis, early diagnosis, and the most appropriate treatment for this clinical condition. Many authors have reported a high mortality caused by difficulties in making an accurate diagnosis resulting in the use of inappropriate therapy for so called crypto-symptomatic acute pancreatitis. The factor suspected to be responsible for the increased frequency of the gastroenterological diseases and for their masked onset seems to be immunosuppression, especially by corticosteroids. The case of a 46-year-old male patient with cardiac transplant, who, 3 years after the transplantation, developed mild acute pancreatitis, is presented. The immunosuppressive regimen he followed was based on cyclosporine. The acute pancreatitis was treated conservatively with a satisfactory outcome. In the course of the illness the patient developed a pancreatic pseudocyst that was managed successfully by percutaneous drainage. The patient is currently being followed up, and both his medical ailments and health-related quality of life are being monitored, while he continues to show mild symptoms of chronic pancreatitis.

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Acute pancreatitis after cardiac transplantation

Cited by 19 publications

References 9 publications

Factors Influencing Mortality in Acute Pancreatitis

Factors Influencing Mortality in Acute Pancreatitis

Acute Pancreatitis: Bench to the Bedside

Pancreatitis Following Heart Transplantation: Report of a Case

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