title: Emergency surgical treatment of complicated acute pancreatitis after kidney transplantation with acute rejection: Case report and literature review.
abstract: BACKGROUND
  Acute pancreatitis is a rare but frequently fatal complication in patients following kidney transplantation. The first case of acute pancreatitis in patients following a kidney transplant was described by Starzl in 1964. The incidence of acute pancreatitis is stated at between 1 and 5%. The mortality rate amongst these patients reaches as high as 50-100%.
  
  
  METHODS
  Here we present a case of acute pancreatic abscess in a caucasian female - shortly following a kidney transplant complicated by the development of acute rejection, in which immunosuppressant therapy is a potential etiological agent. Emergency surgical treatment was indicated, which included drainage of the abscesses irrigation of the abdominal cavity. Immunosuppressive medication was considered a possible etiological factor, and as a result administration of tacrolimus and mycophenolate mofetil was discontinued. This was successful and three months later, diagnostic rebiopsy of the graft was performed without signs of rejection.
  
  
  CONCLUSIONS
  The etiology of this illness is multifactorial. The clinical manifestation of acute pancreatitis in patients following kidney transplantation is the same as in the remainder of the population. However, in patients following transplantation with long-term immunosuppression, it usually manifests a more rapid development and a more severe, frequently fatal course.
  
  
  CONCLUSIONS
  With regard to the patient's comorbidities, early surgical therapy was indicated - drainage and closed lavage and immunosuppressive medication as a suspected tobe ethiological factor was discontinued. This course of treatment led to a complete recovery with preservation of good function of the cadaverous kidney.
authors.affiliation: Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P.Pavlova 6, CZ-77900, Olomouc, Czech Republic.
authors.forename: Dušan
authors.initials: D
authors.lastname: Klos
authors.affiliation: Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P.Pavlova 6, CZ-77900, Olomouc, Czech Republic.
authors.forename: Jiří
authors.initials: J
authors.lastname: Orság
authors.affiliation: Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P.Pavlova 6, CZ-77900, Olomouc, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Loveček
authors.affiliation: Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P.Pavlova 6, CZ-77900, Olomouc, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Skalický
authors.affiliation: Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P.Pavlova 6, CZ-77900, Olomouc, Czech Republic.
authors.forename: Roman
authors.initials: R
authors.lastname: Havlík
authors.affiliation: Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P.Pavlova 6, CZ-77900, Olomouc, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Zadražil
authors.affiliation: Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I.P.Pavlova 6, CZ-77900, Olomouc, Czech Republic.
authors.forename: Čestmír
authors.initials: Č
authors.lastname: Neoral
keywords: Acute pancreatitis; Immunosuppressant therapy; Renal transplantation