Effect of Different Immunosuppressive Agents on Acute Pancreatitis

Foitzik, Thomas; Forgács, B.; Ryschich, Eduard; Hotz, Hubert G.; Gebhardt, M. M.; Buhr, H. J.; Klar, E.

doi:10.1097/00007890-199804270-00004

Cited by 27 publications

(24 citation statements)

References 40 publications

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“…There is also a number of case reports where acute pancreatitis was associated with Crohn's disease alone and several studies have reported pancreatic insufficiency in Crohn's disease [23][24][25][26][27] In addition, one study showed that in an animal model of acute pancreatitis in rats, the use of azathioprine worsened the inflammation. 28 These findings taken together might suggest that azathioprine exacerbates an already inflamed pancreas in Crohn's disease.…”

Section: Discussionmentioning

confidence: 97%

Increased incidence of azathioprine‐induced pancreatitis in Crohn's disease compared with other diseases

Weersma¹,

Peters²,

Oostenbrug³

et al. 2004

Aliment Pharmacol Ther

108

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Summary Background : Azathioprine is widely used in Crohn's disease. A major drawback is the occurrence of side‐effects, especially acute pancreatitis. Acute pancreatitis is rarely seen when azathioprine is used for other diseases than Crohn's disease. Aim : To survey side‐effects of azathioprine after liver or renal transplantation, for systemic lupus erythematosis, Wegener's granulomatosis, autoimmune hepatitis, rheumatoid arthritis, ulcerative colitis or Crohn's disease. Methods : A computerized search using the term ‘azathioprine’ or ‘imuran’ was performed on the Hospital Information System of the university hospital Groningen, resulting in 1564 patients matching our criteria. Results : Eleven of 224 patients with Crohn's disease experienced acute pancreatitis (4.9%) compared with two of 129 (1.5%) with autoimmune hepatitis, two of 388 (0.5%) after renal transplantation, one of 254 (0.4%) after liver transplantation. Acute pancreatitis was more prevalent in Crohn's disease compared with any other disease. Azathioprine‐toxicity necessitating withdrawal occurred significantly (P < 0,05) more in rheumatoid arthritis(78 of 317), ulcerative colitis (20 of 94) and Crohn's disease (52 of 224) compared with systemic lupus erythematosis (five of 73), Wegener's granulomatosis (six of 85), autoimmune hepatitis (eight of 129), after liver transplantation (17 of 254) and after renal transplantation (22 of 388). Conclusions : Acute pancreatitis is strongly associated with Crohn's disease and rarely occurs with other underlying conditions. Overall azathioprine‐induced toxicity and the necessity of withdrawal is more common in inflammatory bowel disease and rheumatoid arthritis compared with other diseases.

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Section: Discussionmentioning

confidence: 97%

Increased incidence of azathioprine‐induced pancreatitis in Crohn's disease compared with other diseases

Weersma¹,

Peters²,

Oostenbrug³

et al. 2004

Aliment Pharmacol Ther

108

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“…Empirical reduction of dosage or withdrawal of azathioprine is one of the strategies recommended. Experimental evidence suggests that prednisolone, low doses of cyclosporine, and OKT3 monoclonal antibodies are well tolerated in murine pancreatitis but azathioprine and high doses of cyclosporine may aggravate pancreatic injury (9). All of our five patients had evidence of recent viral infection – chicken pox in two, CMV in two and hepatitis E in one.…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis following kidney transplantation – role of viral infections

Sinha

Jha

Lakhtakia

et al. 2003

Clinical Transplantation

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Acute pancreatitis following renal transplantation is an unusual complication that carries a high mortality. Over the last 10 yr, five of 185 patients at our center developed acute pancreatitis. All had live related donors and were on conventional triple drug immunosuppression. Pancreatitis was classified according to the computed tomography scan based on Atlanta Classification. All five patients who developed acute pancreatitis had evidence of symptomatic or serologically active viral infection (chicken pox in two, cytomegalovirus infection in two, hepatitis E virus in one) and no patient without viral infection developed pancreatitis. Overall, 45 patients developed symptomatic or serologically active viral infection. There was a significant association between viral infection and pancreatitis (chi-square test, p < 0.001). Three patients with severe acute pancreatitis died while both patients with mild pancreatitis survived. An active search for viral infections should be made in all patients with acute pancreatitis. Specific antiviral measures may help reduce the mortality of acute pancreatitis in these patients. Consideration must be given to varicella immunization in patients with renal failure.

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“…After the operation, there was a late onset of graft function and the patient was haemodialysis dependent. A biopsy performed 7 days after transplantation confirmed severe combined acute cellular (2B according to Banff 2007 classification) and antibody mediated C4d positive rejection, which was treated intravenously with rabbit antithymocyte globulin (700 mg in 7 doses á 100 mg) in parallel with plasmapheresis [7] and intravenous immunoglobulins (total dose 75 mg). This treatment was successful, with recovery the graft function.…”

Section: Presentation Of Casementioning

confidence: 99%

Emergency surgical treatment of complicated acute pancreatitis after kidney transplantation with acute rejection: Case report and literature review

Klos

Orság

Loveček

et al. 2016

Annals of Medicine &Amp; Surgery

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IntroductionAcute pancreatitis is a rare but frequently fatal complication in patients following kidney transplantation. The first case of acute pancreatitis in patients following a kidney transplant was described by Starzl in 1964. The incidence of acute pancreatitis is stated at between 1 and 5%. The mortality rate amongst these patients reaches as high as 50–100%.Presentation of caseHere we present a case of acute pancreatic abscess in a caucasian female – shortly following a kidney transplant complicated by the development of acute rejection, in which immunosuppressant therapy is a potential etiological agent. Emergency surgical treatment was indicated, which included drainage of the abscesses irrigation of the abdominal cavity. Immunosuppressive medication was considered a possible etiological factor, and as a result administration of tacrolimus and mycophenolate mofetil was discontinued. This was successful and three months later, diagnostic rebiopsy of the graft was performed without signs of rejection.DiscussionThe etiology of this illness is multifactorial. The clinical manifestation of acute pancreatitis in patients following kidney transplantation is the same as in the remainder of the population. However, in patients following transplantation with long-term immunosuppression, it usually manifests a more rapid development and a more severe, frequently fatal course.ConclusionsWith regard to the patient's comorbidities, early surgical therapy was indicated – drainage and closed lavage and immunosuppressive medication as a suspected tobe ethiological factor was discontinued. This course of treatment led to a complete recovery with preservation of good function of the cadaverous kidney.

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Effect of Different Immunosuppressive Agents on Acute Pancreatitis

Cited by 27 publications

References 40 publications

Increased incidence of azathioprine‐induced pancreatitis in Crohn's disease compared with other diseases

Increased incidence of azathioprine‐induced pancreatitis in Crohn's disease compared with other diseases

Acute pancreatitis following kidney transplantation – role of viral infections

Emergency surgical treatment of complicated acute pancreatitis after kidney transplantation with acute rejection: Case report and literature review

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