MANAGEMENT OF SEVERE PANCREATITIS IN RENAL-TRANSPLANT RECIPIENTS

Objective The authors determine if any aspects of the treatment of ren al transplant patients with pancreatitis were of particular benefit wi th regard to graft and patient survival. Background The incidence of p ancreatitis in renal transplant patients is low (1%-2%), but the morta lity of the disease approaches 100%. Although several descriptive repo rts have been published, there is no consensus regarding management. M ethods The authors conduct a retrospective chart review. Results Twent y-one patients were identified with posttransplant pancreatitis (1.3% incidence). The cause of pancreatitis was presumed to be maintenance i mmunosuppression in ail cases. Patients were classified by dynamic com puted tomography (CT) scans having 1) mild/edematous disease (4 patien ts), 2) localized abscess or pseudocyst (6 patients), or 3) severe dis ease (11 patients). Patients with mild/edematous pancreatitis did well with medical management. The six patients with localized abscess or p seudocyst were successfully treated with standard operative interventi on. Of the 11 patients with severe disease, 6 had several days of inte nsive medical management before operation, and all died. The other fiv e patients underwent early operative intervention based principally on CT scan findings, and all survived. The latter group had multiple ope rations and four of five had functioning renal allografts al discharge . Conclusion The severity of pancreatitis in the posttranplant patient may be difficult to assess by clinical criteria. Dynamic CT scanning is, therefore, essential in defining the extent of disease. Early, and perhaps repeated, operations may be lifesaving in those patients havi ng CT scan findings of severe pancreatitis.