Acute pancreatitis following adult liver transplantation: A systematic review

Abstract

Although uncommon, acute pancreatitis is a well-recognized, but generally serious, complication following liver transplantation. In addition to being more prevalent in patients who underwent liver transplantation than in the general population, it has a more aggressive course and can be responsible for significant morbidity and mortality. The post-liver transplant population has altered anatomy, increased comorbidities, and requires a myriad of drugs. These characteristics make them different from the pre-transplant population. Despite their retrospective nature, prior studies have identified numerous etiological factors that are associated with an increased risk of acute pancreatitis following liver transplantation. These can be broadly classified into the following four categories: surgical and anatomical factors, infections, post-transplant management, and post-transplant complications. The aim of this systematic review is to assimilate the available information regarding acute pancreatitis following adult liver transplantation to describe the risk factors and natural history of the disease and to highlight possible areas for further investigation.

Therapeutic Management of Trauma-related Acute Pancreatitis in a Heart Transplant Recipient

“…Patients with heart, liver, intestinal kidney or bone marrow transplantation have a higher prevalence of developing acute pancreatitis compared to the others patients either by exogenous mechanism or by the druginduced pancreatitis mechanism [10,11,14]. The pathophysiology is altered by the immunosuppressive treatment, which increases mortality risk in transplanted versus non-transplanted patients [6,11].…”

“…Severe acute pancreatitis can be associated with systemic inflammation, compensator y immunesuppression, secondary infections, vital organ dysfunction, and death [12]. The diagnosis and treatment can be delayed because transplanted patients are under immunosuppression treatment and they can develop a crypto-symptomatic acute pancreatitis, a fact that increases mortality in orthotropic heart transplant patients [1,11,14,15]. Even with aggressive and appropriate care, the patient can develop acute necrotizing pancreatitis witch has a high mortality rate [2].…”

“…Orthotopic cardiac transplantation and acute pancreatitis are associated with high mortality, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] appearance of necrotic tissue in acute pancreatitis creating conditions for bacterial infection and development of disorders in the coagulation cascade followed by disseminated intravascular coagulation [17]. Normally, amylase/ creatinine clearence rise in acute pancreatitis but because of chronical renal failure induced by ismunosupressiv treatament, clearance in decresed and hyperamilasemia can have elevated serum levels above normal [17].…”

Acute Pancreatitis: A Rare but Serious Complication for Living Liver Donors; Risk Factors and Outcomes

“…Postoperative acute pancreatitis has an aggressive course in these patients, with high mortality ranging from 37.5% to 63%. 33 However, PAP is a rare complication in living liver donors. To our knowledge, the reported rate of 1.7% in this study is the highest PAP rate in living liver donors reported to date.…”

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

“…The estimated incidence of post-liver transplant pancreatitis is 3-8% with an associated 38-63% mortality [54,55]. Factors associated with, and possible causes of, acute pancreatitis can be broadly classified into four groups including infection, medications, surgical factors, and post-transplant complications [54][55][56]. Prior studies suggest that there is a statistically significant association between Hepatitis B virus as the indication for transplantation and post-transplant pancreatitis (seen in up to 30% of cases).…”