Redefining late acute graft pancreatitis: clinical presentation, radiologic findings, principles of management, and prognosis.
OBJECTIVE
To define the incidence, clinical presentation, radiologic findings and principles of diagnosis, and management of acute graft pancreatitis occurring more than 3 months after transplantation.


BACKGROUND
Acute graft pancreatitis is a frequent late complication after simultaneous pancreas-kidney transplantation (SPKT) with enteric drainage that is not well understood.


METHODS
We performed a retrospective analysis of data from patients who underwent SPKT with enteric drainage at our institution. All recipients who experienced episodes that met the clinical criteria for late graft pancreatitis were included. We excluded events proven to be anastomotic or duodenal stump leaks. Clinical presentation, laboratory findings, radiologic imaging, course of management, and graft and patient outcome were evaluated and analyzed.


RESULTS
Of 79 SPKTs (1995-2007), 11 (14%) recipients experienced 31 episodes of late graft pancreatitis (average number per patient, 3; range, 1-13), occurring an average of 28 months after transplantation (range, 3 months to 8 years). All patients presented with right lower quadrant abdominal peritonitis, fever, and findings compatible with pancreas graft inflammation on computed tomography or ultrasound imaging. Mild hyperamylasemia (>110 IU/L) was found in 82% of cases. Treatment was conservative, including bowel rest, antibiotics, and percutaneous sampling and drainage of abscesses as necessary. Excellent graft and patient survival were achieved.


CONCLUSIONS
The diagnosis of late acute graft pancreatitis is clinical, with confirmatory computed tomography or ultrasound imaging. Conservative treatment yields excellent graft and patient survival.
Department of Surgery B, Tel Aviv University, Tel-Aviv, Israel.
Risa M
RM
Small
Ilanit
I
Shetzigovski
Arye
A
Blachar
Jacob
J
Sosna
Joseph M
JM
Klausner
Richard
R
Nakache
Menahem
M
Ben-Haim
D000208:Acute Disease; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D010195:Pancreatitis / Q000175:diagnosis* / Q000628:therapy*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy*; D011379:Prognosis; D051437:Renal Insufficiency / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed