Risk factors for and management of graft pancreatitis.

Abstract

PURPOSE OF REVIEW:

Systematic and detailed analysis of risk factors, pathophysiology, clinical manifestation, diagnosis and management of graft pancreatitis in its different forms, that is acute and chronic graft pancreatitis (A-GP and C-GP), and A-GP being further distinguished into: physiological (P-AGP), early (E-AGP) and late AP (L-AGP).

RECENT FINDINGS:

Graft pancreatitis is the second most-frequent complication following pancreas transplantation. P-AGP is an unavoidable entity related to ischemic reperfusion injury. It is usually clinically silent. It is a timely and prognostically self-limited process. E-AGP occurs within 3 months after pancreas transplantation (PTx) in 35% of cases and is associated with high rates of graft loss (78-91%). Clinical signs are pain, systemic inflammatory response (SIRS) and haematuria. Therapy can be medical, interventional and surgical. L-AGP occurs 3 months following PTx in 14-25% of cases and represents an uncommon cause of graft loss. Typical clinical signs are pain, abdominal tenderness and fever. Typical laboratory signs are hyperamylasaemia, hyperglycaemia and hypercreatininaemia. Therapy is usually conservative. C-GP is difficult to be distinguished from chronic rejection and is associated to graft loss in 4-10% of cases. Recurrent A-GPs and infections are the main risk factors. Specific symptoms are chronic abdominal malaise, constipation and recurrence of DM. Isolated hyperglycaemia is typical of C-GP. The therapy is usually conservative.

SUMMARY:

This systematic analysis of different manifestations of graft pancreatitis provides the basis for a clinical approach to tackling this complex entity.

• Authors: Silvio Nadalin, Paolo Girotti, Alfred Königsrainer
• Journal: Current opinion in organ transplantation (Curr Opin Organ Transplant) Vol. 18 Issue 1 Pg. 89-96 (Feb 2013) ISSN: 1531-7013 [Electronic] United States
• PMID: 23254701 (Publication Type: Journal Article, Review)

Topics

• Acute Disease
• Chronic Disease
• Graft Rejection (diagnosis, etiology)
• Humans
• Hyperglycemia (etiology)
• Pancreas (blood supply)
• Pancreas Transplantation (adverse effects)
• Pancreatitis, Graft (diagnosis, etiology, physiopathology, therapy)
• Prognosis
• Reperfusion Injury (complications)
• Risk Factors