Verran D J, Gurkan A, Chui A K, Dilworth P, Koorey D, McCaughan G, Sheil A G
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Liver Transpl. 2000 May;6(3):362-6. doi: 10.1053/lv.2000.5203.
Acute pancreatitis (AP) has been described after orthotopic liver transplantation but is uncommon in stable patients after the initial perioperative phase. The aim of this study is to review our experience with AP occurring more than 2 months after primary allografting and determine possible contributing factors plus patient outcome. A review of patient files and the unit database was performed. AP was diagnosed in 9 of 298 patients (3%) on 12 occasions. The incidence of AP was greater in men (8 of 163 men) than women (1 of 135 women; P <.04). Underlying factors to each episode of AP were biliary manipulation (4 of 12 episodes; 33%), history of recent alcohol ingestion (3 of 12 episodes; 25%), and malignancy in the region of the pancreas (2 of 12 episodes; 16%). AP was associated with a diagnosis of either hepatic artery thrombosis combined with biliary tract complications (P <.005) or malignancy (P <.004). In 7 of 12 episodes of AP (58%), conservative management alone was successful. In 3 of 9 patients (33%), subsequent surgery was required. One patient died of pancreatic malignancy. In conclusion, AP is uncommon in stable liver transplant recipients. Male sex, complications of hepatic artery thrombosis, and malignancy in the region of the pancreas are associated with AP in this study.
原位肝移植后曾有急性胰腺炎（AP）的报道，但在围手术期初始阶段后的稳定患者中并不常见。本研究的目的是回顾我们在初次移植后2个月以上发生AP的经验，并确定可能的促成因素及患者预后。我们对患者病历和科室数据库进行了回顾。298例患者中有9例（3%）在12次情况下被诊断为AP。男性AP的发生率（163名男性中有8例）高于女性（135名女性中有1例；P<.04）。每次AP发作的潜在因素包括胆道操作（12次发作中有4次；33%）、近期饮酒史（12次发作中有3次；25%）以及胰腺区域的恶性肿瘤（12次发作中有2次；16%）。AP与肝动脉血栓形成合并胆道并发症（P<.005）或恶性肿瘤（P<.004）的诊断相关。在12次AP发作中的7次（58%），仅保守治疗即取得成功。9例患者中有3例（33%）需要后续手术。1例患者死于胰腺恶性肿瘤。总之，AP在稳定的肝移植受者中并不常见。本研究中，男性、肝动脉血栓形成并发症以及胰腺区域的恶性肿瘤与AP相关。
