title: Risk factors for and management of graft pancreatitis.
abstract: OBJECTIVE
  Systematic and detailed analysis of risk factors, pathophysiology, clinical manifestation, diagnosis and management of graft pancreatitis in its different forms, that is acute and chronic graft pancreatitis (A-GP and C-GP), and A-GP being further distinguished into: physiological (P-AGP), early (E-AGP) and late AP (L-AGP).
  
  
  RESULTS
  Graft pancreatitis is the second most-frequent complication following pancreas transplantation. P-AGP is an unavoidable entity related to ischemic reperfusion injury. It is usually clinically silent. It is a timely and prognostically self-limited process. E-AGP occurs within 3 months after pancreas transplantation (PTx) in 35% of cases and is associated with high rates of graft loss (78-91%). Clinical signs are pain, systemic inflammatory response (SIRS) and haematuria. Therapy can be medical, interventional and surgical. L-AGP occurs 3 months following PTx in 14-25% of cases and represents an uncommon cause of graft loss. Typical clinical signs are pain, abdominal tenderness and fever. Typical laboratory signs are hyperamylasaemia, hyperglycaemia and hypercreatininaemia. Therapy is usually conservative. C-GP is difficult to be distinguished from chronic rejection and is associated to graft loss in 4-10% of cases. Recurrent A-GPs and infections are the main risk factors. Specific symptoms are chronic abdominal malaise, constipation and recurrence of DM. Isolated hyperglycaemia is typical of C-GP. The therapy is usually conservative.
  
  
  CONCLUSIONS
  This systematic analysis of different manifestations of graft pancreatitis provides the basis for a clinical approach to tackling this complex entity.
authors.affiliation: Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Germany. silvio.nadalin@med.uni-tuebingen.de
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Paolo
authors.initials: P
authors.lastname: Girotti
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
mesh_terms: D000208:Acute Disease; D002908:Chronic Disease; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D010179:Pancreas / Q000098:blood supply; D016035:Pancreas Transplantation / Q000009:adverse effects*; D055589:Pancreatitis, Graft / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D015427:Reperfusion Injury / Q000150:complications*; D012307:Risk Factors