title: Use of drotrecogin alpha (recombinant human activated protein C, rhAPC) in the treatment of severe sepsis induced by graft pancreatitis after simultaneous pancreas and kidney transplantation: a case report.
abstract: We present our experience with recombinant human activated protein C (rhAPC) to treat a 40-year-old preemptive simultaneous pancreas-kidney transplant (spktx) recipient who developed septic shock due to graft pancreatitis. We diagnosed intra-abdominal septic complications with septicemia induced by multiple pathogens and cardiopulmonary insufficiency. Until the 59th posttransplant day, 21 peritoneal lavages were performed to treat peritonitis and intra-abdominal abscesses. On the 53rd day when septic shock was diagnosed, rhAPC was administered, after which the patient improved, vasoconstrictive agents were reduced, and respiratory insufficiency resolved. The Physiologic and Operative Severity Score for enumeration of Mortality and Morbidity (POSSUM) scale showed a decrease in predicted mortality from 93% to 17% on day 7 after rhAPC initiation. The patient was discharged at 128 days after spktx with good function of both grafts. Administration of rhAPC limited systemic inflammatory response syndrome (SIRS) and may be considered when faced with the dilemma of stopping immunosuppression to save a recipient's life but at the cost of rejection of a functioning graft.
authors.affiliation: Department of General, Vascular and Transplant Surgery, Warsaw Medical University, ul. Banacha 1a, 02-097 Warsaw, Poland. trgroch@amwaw.edu.pl
authors.forename: T
authors.initials: T
authors.lastname: Grochowiecki
authors.forename: S
authors.initials: S
authors.lastname: Nazarewski
authors.forename: J
authors.initials: J
authors.lastname: Meszaros
authors.forename: A
authors.initials: A
authors.lastname: Kanski
authors.forename: M
authors.initials: M
authors.lastname: Wojtaszek
authors.forename: C
authors.initials: C
authors.lastname: Kosinski
authors.forename: J
authors.initials: J
authors.lastname: Wyzgal
authors.forename: J
authors.initials: J
authors.lastname: Szmidt
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods; D010195:Pancreatitis / Q000175:diagnosis*; D011183:Postoperative Complications / Q000175:diagnosis*; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated