Acute pancreatitis after cardiac transplantation and other cardiac procedures: Case-control analysis in 24,631 patients

Previous series have identified an increased risk of developing acute posto perative pancreatitis in heart transplant recipients and other cardiac surg ical patients, and some suggest that mortality is significantly increased w hen pancreatitis occurs in the transplant setting. We conducted a retrospec tive case-central analysis of adult patients undergoing orthotopic heart tr ansplant or other cardiac procedures from April 1985 through June 1996 at o ur medical center. Specific risk factors for outcome were assessed includin g low cardiac output, intra-aortic balloon pump usage, exogenous calcium re pletion, immunosuppression, cytomegalovirus infection, cholelithiasis, prio r pancreatitis, and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. There was a 30-fold increase in the incidence of pancreatitis i n the heart transplant group [12 of 394 (3%) vs 27 of 24,237 (0.1%); P < 0. 01]. Compared with the nontransplant cardiopulmonary bypass patients, the t ransplant patients experienced a statistically significant increased incide nce of immunosuppression and three or more risk factors. Transplant patient s with pancreatitis demonstrated a significant increase in APACHE II scores and the incidence of three or more risk factors compared with their transp lant control group. Patients undergoing nontransplant cardiac procedures an d developing pancreatitis had significantly increased crossclamp times, inc idence of low cardiac output, APACHE II scores, and incidence of three or m ore risk factors compared with their nontransplant cohort. In conclusion, t here is a significant increase in the incidence of pancreatitis after ortho topic heart transplant compared with other cardiac procedures. Analysis dem onstrates the additive effect of multiple individual risk factors. Immunosu ppression confers significant additional risk for pancreatitis in the ortho topic heart transplant patient.