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Pancreatitis after liver transplantation in children: a single-center experience
Bijan Eghtesad1, Jorge D Reyes, Mahmood Ashrafi
1The Thomas E. Starzl Transplantation Institute and Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA. eghtesadb@msx.upmc.edu.
Insights
Posttransplantation acute pancreatitis (PTAP) is a serious complication in pediatric liver transplant (LTx) recipients. Risk factors include retransplantation and aortic grafts, with early intervention potentially improving outcomes.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Gastroenterology
Background:
- Posttransplantation acute pancreatitis (PTAP) is a rare but significant complication following pediatric liver transplantation (LTx).
- Understanding PTAP's impact is crucial for improving outcomes in pediatric liver transplant recipients.
Purpose of the Study:
- To define the incidence and impact of PTAP in a large cohort of pediatric liver transplant recipients.
- To identify risk factors and outcomes associated with PTAP in children.
Main Methods:
- Retrospective review of pediatric liver transplant recipients from January 1986 to December 1999.
- Analysis of patient demographics, transplant indications, PTAP occurrence, associated factors, management, and mortality.
Main Results:
- Twenty-six of 634 pediatric LTx recipients developed PTAP, often early post-transplant (61% within the first week).
- Risk factors included infrarenal aortic grafts (54%), retransplantation (42%), blood loss, and prolonged surgery.
- PTAP was associated with acute renal failure (58%) and high mortality (42%); 45% survival with operative intervention for complicated cases.
Conclusions:
- Retransplantation, extensive dissection, and infrarenal aortic grafts are key risk factors for PTAP in pediatric LTx.
- Early surgical exploration and debridement may improve outcomes in complicated PTAP.
- Retransplantation with existing pancreatitis carries a high failure rate.
Background And Method:
Posttransplantation acute pancreatitis (PTAP) is a rare but serious complication after pediatric liver transplantation (LTx). We performed a retrospective review in a large cohort of pediatric liver transplant recipients at a single institution to define the impact of this problem in children.
Results:
Between January 1986 and December 1999, 634 pediatric LTx were performed. Twenty-six patients developed serious acute pancreatitis. The mean age at transplantation was 7.7 years (9 months to 19 years), and the indications for transplantation were biliary atresia in seven, fulminant hepatic failure in six, chronic rejection in seven, and other etiologies in six patients. PTAP was more likely to occur early after LTx (61% within the first week), was associated with the presence of an infrarenal aortic graft in 14 (54%) of 26 patients, was more likely to occur after retransplantation (11/26 patients), and was associated with blood loss and prolonged surgery in four cases. Acute renal failure occurred in 15 (58%) of 26 patients. Mortality was 42% (11/26); causes of death were sepsis or multiple organ failure in nine and hemorrhage in two patients. Management of PTAP included antibiotics, sphincterotomy, debridement with drainage, hepatic arterial revascularization, and arterial ligation. Of the 14 patients with complicated pancreatitis, 5 were treated conservatively and died. Nine patients had extensive operative interventions and four survived (45%).
Conclusions:
Several risk factors such as retransplantation, extensive dissection at the time of LTx, and use of infrarenal arterial graft contribute to development of PTAP in children. Early exploration and debridement in patients with complicated pancreatitis may result in a better outcome. Retransplantation in the presence of clinical pancreatitis has a high failure rate.