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Development of intrapancreatic abscess--a consequence of CMV pancreatitis?
L Bäckman1, C Brattström, F P Reinholt
1Department of Transplantation Surgery, Huddinge Hospital, Sweden.
Abstract:
Cytomegalovirus (CMV) pancreatitis was diagnosed in eight out of 124 pancreatic transplant recipients. Five of the eight patients developed intrapancreatic abscesses and four of the grafts were lost, but one is still functioning. In the three additional cases of pancreatitis, antiviral treatment with foscarnet or ganciclovir was given as soon as signs of CMV pancreatitis were detected. No such grafts were lost during the acute phase. CMV infection was diagnosed in cells from pancreatic juice, by virus isolation, detection of CMV antigen in cells from pancreatic juice or by CMV serology. The signs and symptoms of CMV pancreatitis included fever, general malaise, abdominal pain, diarrhoea, localized peritonitis, hyperamylasaemia, leukopenia and hyperglycaemia. It is recommended that rapid diagnostic procedures for CMV should be carried out when early signs of pancreatitis develop in pancreatic graft recipients. Antiviral treatment should be given when CMV pancreatitis is suspected or diagnosed in order to prevent the development of intrapancreatic abscesses and graft loss.
Insights
Cytomegalovirus (CMV) pancreatitis is a serious risk for pancreatic transplant recipients, potentially leading to graft loss. Early diagnosis and antiviral treatment are crucial to prevent complications like abscesses and preserve graft function.
Area of Science:
- Transplant Surgery
- Virology
- Immunology
Background:
- Pancreatic transplantation is a complex procedure with potential complications.
- Cytomegalovirus (CMV) infection is a known risk in immunosuppressed transplant recipients.
Observation:
- CMV pancreatitis was identified in 8 of 124 pancreatic transplant recipients.
- Symptoms included fever, abdominal pain, hyperamylasemia, and leukopenia.
- Five patients developed intrapancreatic abscesses, and four grafts were lost.
Findings:
- Rapid diagnostic methods for CMV, including analysis of pancreatic juice and serology, are effective.
- Prompt antiviral treatment with foscarnet or ganciclovir prevented graft loss in three additional cases.
- Early intervention significantly reduces the risk of severe complications.
Implications:
- Implementing rapid CMV diagnostics in pancreatic transplant recipients with pancreatitis symptoms is recommended.
- Early antiviral therapy is vital for preventing intrapancreatic abscesses and pancreatic graft failure.
- This approach can improve patient outcomes and graft survival rates.