title: Acute necrotizing pancreatitis and severe hepatic failure: description of three cases.
abstract: BACKGROUND
  Acute pancreatitis is not uncommon in fulminant hepatic failure (FHF) as confirmed by histology or serology. A few reports exist of symptomatic pancreatitis in the setting of acute viral hepatitis; the diagnosis is usually made intraoperatively or postmortem. We report three cases of liver transplant (OLT) recipients with severe acute liver failure and severe acute pancreatitis as an intraoperative finding.
  
  
  METHODS
  We undertook a retrospective review among a large cohort of liver transplant recipients to define the impact of this problem.
  
  
  RESULTS
  Between 1999 and 2007, 293. LTs were performed including 15 (5%) who had severe acute liver failure (nine with FHF and six with an emergency retransplantation [ER]). Among this group, three patients were diagnosed intraoperatively with acute necrotizing pancreatitis (ANP): two patients with associated FHF and one with an ER due to ABO incompatibility. None of the patients had symptoms of pancreatitis. In all, ANP was classified as Balthazar CT grade D-E, which determined the outcome. All the patients developed a pseudocyst and abscess, which required surgical drains.
  
  
  CONCLUSIONS
  ANP was diagnosed as an intraoperative finding in patients with FHF. The mechanism of pancreatitis in patients with FHF is unknown. It may be multifactorial (virus, acute liver failure, hypotension, infection, drug-induced lesion,). This association leads to a worse outcome due to the complications.
authors.affiliation: Liver Transplant Unit, University Hospital, Lozano Blesa, Zaragoza, Spain. vbernalm@gmail.com
authors.forename: V
authors.initials: V
authors.lastname: Bernal Monterde
authors.forename: A
authors.initials: A
authors.lastname: Campillo Arregui
authors.forename: C
authors.initials: C
authors.lastname: Sostres Homedes
authors.forename: A
authors.initials: A
authors.lastname: García Gil
authors.forename: M A
authors.initials: MA
authors.lastname: Simón Marco
authors.forename: M T
authors.initials: MT
authors.lastname: Serrano Aulló
mesh_terms: D005260:Female; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications*; D012189:Retrospective Studies