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

Abstract

Acute pancreatitis (AP) has been described after orthotopic liver transplantation but is uncommon in stable patients after the initial perioperative phase. The aim of this study is to review our experience with AP occurring more than 2 months after primary allografting and determine possible contributing factors plus patient outcome. A review of patient files and the unit database was performed. AP was diagnosed in 9 of 298 patients (3%) on 12 occasions. The incidence of AP was greater in men (8 of 163 men) than women (1 of 135 women; P F .04). Underlying factors to each episode of AP were biliary manipulation (4 of 12 episodes; 33%), history of recent alcohol ingestion (3 of 12 episodes; 25%), and malignancy in the region of the pancreas (2 of 12 episodes; 16%). AP was associated with a diagnosis of either hepatic artery thrombosis combined with biliary tract complications (P F .005) or malignancy (P F .004). In 7 of 12 episodes of AP (58%), conservative management alone was successful. In 3 of 9 patients (33%), subsequent surgery was required. One patient died of pancreatic malignancy. In conclusion, AP is uncommon in stable liver transplant recipients. Male sex, complications of hepatic artery thrombosis, and malignancy in the region of the pancreas are associated with AP in this study. (Liver Transpl 2000;6:362-366.)

Acute pancreatitis following adult liver transplantation: A systematic review

“…Although a majority of cases of patients with alcoholic cirrhosis must demonstrate 6 months of sobriety prior to being listed for a liver transplantation, recidivism is not uncommon (48). Verran identified alcohol intake as the reason for 25% of cases of postliver transplant pancreatitis, which is similar to the rate seen in the non-transplant population (4,49).…”

“…As with AP in the nontransplant population, the mainstay of management in the reviewed studies consisted of conservative treatment with intravenous fluids and bowel rest with further surgical management as required (2)(3)(4)6,7,50). Although specifications of therapy are not discussed, this seems to be in line with the recommended treatment of AP in the general population (16).…”

“…A number of studies in the post-liver transplant population have demonstrated lower rates of PEP varying between 1% and 6.4% (38), with 2 studies showing that PEP is responsible for 11% of post-liver transplant pancreatitis (4,7). Other procedures that involve direct manipulation of the biliary tract have been shown to cause AP after liver transplantation, including T-tube manipulation or removal, percutaneous trans-hepatic cholangiography, and placement of biliary drains (4). As with the non-transplant population, biliary sludge and stone have been associated with the development of AP following liver transplantation, accounting for 22% of late-onset AP in one series (4).…”

“…Malignancies that involve the biliary tract can present with AP in both the pre-and the post-transplant population, causing up to 22% of post-liver transplant pancreatitis (4,41).…”

“…Among patients who underwent liver transplantation, its prevalence is generally higher than that in the general population, with reported incidence ranging from 3% to 8% (1)(2)(3)(4)(5). It can also have a more aggressive course, with mortality ranging from 37.5% to 63% (2,3,6,7) and is observed in both adult and pediatric populations (8).…”