NATIVE AND GRAFT PANCREATITIS FOLLOWING COMBINED PANCREAS-RENAL TRANSPLANTATION

Ten patients who had undergone whole-organ pancreas transplantation an d pancreatoduodenocystostomy from a total of 60 simultaneous cadaveric kidney-pancreas transplants met the criteria for graft pancreatitis. This condition is clearly different from acute rejection on the basis of marked hyperamylasnemia and significant local findings over the all ograft. Graft rejection was the cause of graft loss in one of the pati ents; eight are alive, seven with a functioning graft 61, 30, 27, 25, 21, 18 and 14 months after transplantation. Two patients died: one fro m severe graft pancreatitis ann the other from cytomegalovirus infecti on. Bladder drainage with or without antibiotics has been the most com mon therapy, based on the theory that damage is caused by duodenal con tent and infected urine reflux. To prevent graft loss, antiviral treat ment should be given when pancreatitis due to cytomegalovirus is suspe cted or diagnosed. Two patients with native pancreatitis are also desc ribed; the disease was severe and surgery was required in both cases. The pancreas grafts have now been functioning for 2 years 7 months and 2 years 10 months respectively.