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Management of severe pancreatitis in renal transplant recipients. Ann Surg 1997 Feb;225(2):217-22

Date

02/01/1997

Pubmed ID

9065299

Pubmed Central ID

PMC1190651

DOI

10.1097/00000658-199702000-00010

Scopus ID

2-s2.0-0031051418   32 Citations

Abstract

OBJECTIVE: The authors determine if any aspects of the treatment of renal transplant patients with pancreatitis were of particular benefit with regard to graft and patient survival.

BACKGROUND: The incidence of pancreatitis in renal transplant patients is low (1%-2%), but the mortality of the disease approaches 100%. Although several descriptive reports have been published, there is no consensus-regarding management.

METHODS: The authors conduct a retrospective chart review.

RESULTS: Twenty-one patients were identified with posttransplant pancreatitis (1.3% incidence). The cause of pancreatitis was presumed to be maintenance immunosuppression in all cases. Patients were classified by dynamic computed tomography (CT) scans having 1) mild/edematous disease (4 patients), 2) localized abscess or pseudocyst (6 patients), or 3) severe disease (11 patients). Patients with mild/edematous pancreatitis did well with medical management. The six patients with localized abscess or pseudocyst were successfully treated with standard operative intervention. Of the 11 patients with severe disease, 6 had several days of intensive medical management before operation, and all died. The other five patients underwent early operative intervention based principally on CT scan findings, and all survived. The latter group had multiple operations and four of five had functioning renal allografts at discharge.

CONCLUSION: The severity of pancreatitis in the posttranplant patients may be difficult to assess by clinical criteria. Dynamic CT scanning is, therefore, essential in defining the extent of disease. Early, and perhaps repeated, operations may be lifesaving in those patients having CT scan findings of severe pancreatitis.

Author List

Slakey DP, Johnson CP, Cziperle DJ, Roza AM, Wittmann DH, Gray DW, Roake JA, Britton J, Morris PJ, Adams MB

Authors

Christopher P. Johnson MD Professor in the Surgery department at Medical College of Wisconsin
Allan M. Roza MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Female
Humans
Kidney Transplantation
Male
Middle Aged
Pancreatitis
Retrospective Studies
Severity of Illness Index
jenkins-FCD Prod-478 d1509cf07a111124a2d122fd3df854cc0b993c00