Acute pancreatitis in patients after liver transplantation

Czech version

Authors: Hujová A. ¹; Peter Mačinga ¹; Jarošová J. ¹; Janečková L. ¹; Froněk J. ²; Pavel Taimr ¹; Julius Špičák ¹; Tomáš Hucl ¹
Authors‘ workplace: Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha ¹; Klinika transplantační chirurgie, Transplantcentrum, IKEM, Praha ²
Published in: Gastroent Hepatol 2020; 74(4): 311-318
Category: Clinical and Experimental Gastroenterology: Original Article
doi: https://doi.org/10.14735/amgh2020311

Overview

Introduction: Acute pancreatitis (AP) is relatively rare but serious complication that may occur after organ transplantation. In the group of patients with liver transplantation, the reported incidence ranges from 1.5 to 8 % and is associated with significant mortality.

Aim and methods: The aim of this study was to assess the incidence, identify potential risk factors and evaluate the course of acute pancreatitis in patients after liver transplantation in the Institute for Clinical and Experimental Medicine. We performed a retrospective analysis of the medical records of all patients who underwent liver transplantation during the period between September 1996 and December 2019.

Results: A total of 1,740 patients underwent liver transplantation during the study period. AP was diagnosed in 50 patients (2.9%), a mild form was present in 40 cases (80%) and a severe form was found in 10 patients (20%), the overall mortality was 10%. An early form of AP (< 30 days from transplantation), arising with an average 10-day delay from transplantation, occurred in 14 patients (28%); most of these patients presented with severe AP (9 patients, 64%) and four of them died (44%). Late form of AP was diagnosed in 36 patients (72%) with a mean delay of 40 months from transplantation; in most of the cases, the course of AP was mild (35 patients, 97%), one patient with severe AP died. The most common etiology of AP were post-endoscopic retrograde cholangio pancreatography (38%), idiopathic (26%), post-operative (14%) and drug-induced (12%). Complications occurred in nine patients. Three patients underwent surgical treatment. Chronic hepatitis B virus (HBV) infection as the cause of the liver disease leading to liver transplantation was a risk factor for the development of AP (P = 0.012).

Conclusion: AP occurs relatively rarely in liver transplant recipients, but more frequently than in the general population. The overall mortality of the disease was higher compared to the general population despite similar representation of severe and mild form of AP. The unfavorable course was mainly associated with the occurrence of the disease in the early post-transplant period. Liver transplantation for complications of HBV infection was a risk factor for the development of AP.

Conflict of Interest: The authors declare that the article/ manuscript complies with ethical standards, patient anonymity has been respected, and they state that they have no financial, advisory or other commercial interests in relation to the subject matter.

Publication Ethics: This article/ manuscript has not been published or is currently being submitted for another review. The authors agree to publish their name and e-mail in the published article/ manuscript.

Dedication: The article/ manuscript is not supported by a grant nor has it been created with the support of any company.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio medical papers.

Keywords:

liver transplantation – acute pancreatitis

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