Pancreatitis Following Heart Transplantation: Report of a Case

Abstract

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.

Obscured hemorrhagic pancreatitis after orthotopic heart transplantation complicated with acute right heart failure and hepatic dysfunction: a case report

“…Some immunosuppressants, such as corticosteroid, azathioprine, cyclosporine, and (rarely) tacrolimus, are known to be associated with pancreatitis [2, 3]; however, drug-related pancreatitis was not likely in this patient because he eventually recovered without stopping any of these medications. Cytomegalovirus infection is proposed to be another important etiology of pancreatitis in patients who have undergone a transplantation [2, 3], but this was excluded by the patient’s negative antigenemia. Low cardiac output after cardiac surgery is known to be a risk factor for developing postoperative pancreatic cell injury [4].…”

“…The incidence of pancreatitis in patients who have undergone orthotopic heart transplantation ranges from 2 to 18%, which is 15 to 25 times higher than after other cardiac procedures and causes high mortality [1–3] Nevertheless, a diagnosis of pancreatitis after heart transplantation might be difficult and often delayed because of its obscured clinical presentation [1]. Immunosuppressive status after transplantation conceals the systemic inflammatory response and contributes to so-called crypto-symptomatic pancreatitis [3].…”

“…Immunosuppressive status after transplantation conceals the systemic inflammatory response and contributes to so-called crypto-symptomatic pancreatitis [3]. Some immunosuppressants, such as corticosteroid, azathioprine, cyclosporine, and (rarely) tacrolimus, are known to be associated with pancreatitis [2, 3]; however, drug-related pancreatitis was not likely in this patient because he eventually recovered without stopping any of these medications. Cytomegalovirus infection is proposed to be another important etiology of pancreatitis in patients who have undergone a transplantation [2, 3], but this was excluded by the patient’s negative antigenemia.…”

“…Pancreatitis is one of the most serious gastrointestinal complications after cardiac surgery that requires a cardiopulmonary bypass, e.g., a heart transplantation [1–3]. Although some risk factors have been identified, the association between post-transplantation acute right heart failure and pancreatitis has rarely been discussed.…”

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

“…Pancreatitis is associated with high mortality in patients with heart transplantation(HTx) after infections and rejection complications [1]. The mortality rate is very high even if acute necrotizing pancreatitis benefits from suitable treatment [2].…”