Acute pancreatitis after liver transplantation: incidence and contributing factors

Abstract

In order to assess the incidence and possible predisposing and contributing factors in the development of acute pancreatitis after liver transplantation, we reviewed the medical records of all 1832 adult patients who underwent 2161 orthotopic liver transplantation (OLTx) procedures in our center between January 1987 and September 1992. Of these patients, 55 (3% incidence) developed clinical pancreatitis and 247 (13.4% incidence) developed hyperamylasemia (biochemical pancreatitis). Overall mortality in cases of clinical pancreatitis was 63.6%. The mortality in cases of hyperamylasemia was similar to that found in the general liver transplant population (i.e., 23%). A strong correlation was found between pancreatitis after liver transplantation and end‐stage liver disease due to hepatitis B (30% of the cases, P= 0.00001). Extensive surgical dissection around the pancreas (P < 0.05), the type of biliary reconstruction following liver transplantation (P < 0.05), and the number of liver grafts received by the same patient (P= 0.00001) appeared to be possible contributing factors as did the duration of venovenous bypass and the quantity of IV calcium chloride administered intraoperatively.

Pancreatitis in adult orthotopic liver allograft recipients: Risk factors and outcome

“…10,11 Hepatitis B infection has been associated with AP in liver transplant recipients both early and later after OLT. 1,2,12 However, in this series, hepatitis B was not a factor despite OLT being performed for this indication. Although other infectious causes of pancreatitis are described, 13 it is difficult to determine the role that cholangitis had in our patients with AP.…”

“…The incidence of AP has been reported to be as great as 5.7% after orthotopic liver transplantation (OLT), with a mortality rate of up to 64%. 1,2 It is evident that such factors as underlying hepatitis B, multiple organ failure, and retransplantation may be associated with the development of AP, particularly in the early postoperative phase. [1][2][3] However, in 1 reported series, a difference was evident in both the nature of the underlying factors and the ensuing mortality rate in patients with AP.…”

Acute pancreatitis after orthotopic liver transplantation in children

“…The standard techniques used in both transplants do not include extensive dissection around the pancreas. Krokos et al 2 found that in 40 of 55 patients (72.7%) who developed clinical pancreatitis, biliary reconstruction had been carried out with an end-to-side Roux-en-Y choledochojejunostomy anastomosis. This technique, which is our standard procedure in pediatric OLT, was used in both cases.…”

“…[1][2][3] In two large adult series, its incidence varies from 3% to 3.6% and mortality ranges from 53.8% to 63.6%. 2,3 To our knowledge, only 4 cases have been previously mentioned in children.…”

“…[1][2][3] In two large adult series, its incidence varies from 3% to 3.6% and mortality ranges from 53.8% to 63.6%. 2,3 To our knowledge, only 4 cases have been previously mentioned in children. 4 To add to this very limited experience, we report 2 cases of AP following OLT and discuss the mechanism of this complication.…”