Asztalos L, Kincses Z, Berczi C, Szabo L, Fedor R, Locsey L, Balzs G
Debreceni Egyetem Orvos- és Egészségtudományi Centrum, 4012 Debrecen, Nagyerdei krt. 98. Pf. 27.
Magy Seb. 2001 Apr;54(2):91-4.
Pancreatitis following kidney transplantation was first described by Starzl in 1964 [19]. The incidence rate of the disease involving severe complications ranges from 1.2 to 6.8%. The number of risk factors, besides those of the normal population, is increased by a number of other factors, i.e. uremia, disorder of lipid metabolism, polycystic kidney, immunosuppressive drugs, cytomegalovirus infection, etc. The mortality of acute pancreatitis in a kidney transplant patient is, in spite of treatment with the most up-to-date methods, is much higher (53-60%) than that for a non-transplant patient. In the period between 27 June 1991 and 31 December 2000 the number of cadaver kidney transplants performed in the Transplantation Division of the 1st Department of Surgery of the Medical and Health-Science Centre of the University of Debrecen was 349. During this period 9 incidences of acute pancreatitis were found in 8 patients. The frequency of incidence was 2.56%. In the present communication we analyse the prognosis of 9 kidney transplant patients, with special respect to immunosuppression.
One patient was administered Cyclosporin alone, four were given Cyclosporin and Steroids, a further one Cyclosporin, Steroids and Azathioprine, the remaining three were treated with Cyclosporin, steroids and Mycophenolate Mophetil. In six cases out of nine multiorgan insufficiency (kidney, lung, liver) was encountered on presentation, three cases were accompanied by peritonitis. In spite of early jejunal nutrition, intensive therapy, antibiotic treatment, CT monitoring, if needed, necrectomy and oncotomy, three of our patients died from multiorgan insufficiency induced by septico-toxic state (mortality 33.3%). Other six patients recovered.
The mortality rate of acute pancreatitis is much higher in immunosuppressed patients. The role of the etiological factors is not unequivocal in the development of pancreatitis. Nevertheless, all possible risk factors have to be taken into consideration when starting the immunosuppressive treatment of transplant patients and during their follow-up. By optimally adjusting the immunosuppressants we can decrease the risk of pancreatitis, however, the prognosis of the diseases, in agreement with the data in the literature, cannot be considerably improved even with the most up-to-date methods.
肾移植后胰腺炎最早由施塔兹于1964年描述[19]。该疾病伴有严重并发症的发病率在1.2%至6.8%之间。除了正常人群的危险因素外，肾移植患者还因许多其他因素而增加，即尿毒症、脂质代谢紊乱、多囊肾、免疫抑制药物、巨细胞病毒感染等。尽管采用了最新的治疗方法，肾移植患者急性胰腺炎的死亡率（53% - 60%）仍远高于非移植患者。1991年6月27日至2000年12月31日期间，德布勒森大学医学与健康科学中心第一外科移植科进行了349例尸体肾移植。在此期间，在8名患者中发现了9例急性胰腺炎。发病率为2.56%。在本报告中，我们分析了9例肾移植患者的预后情况，特别关注免疫抑制情况。
1例患者仅接受环孢素治疗，4例接受环孢素和类固醇治疗，另有1例接受环孢素、类固醇和硫唑嘌呤治疗，其余3例接受环孢素、类固醇和霉酚酸酯治疗。9例中有6例在就诊时出现多器官功能不全（肾脏、肺、肝脏），3例伴有腹膜炎。尽管进行了早期空肠营养、强化治疗、抗生素治疗、CT监测，必要时进行坏死组织切除术和切开引流术，但我们的3例患者死于败血症中毒状态引起的多器官功能不全（死亡率33.3%）。其他6例患者康复。
免疫抑制患者急性胰腺炎的死亡率高得多。病因在胰腺炎的发生发展中作用并不明确。然而，在开始对移植患者进行免疫抑制治疗及其随访期间，必须考虑所有可能的危险因素。通过优化调整免疫抑制剂，我们可以降低胰腺炎的风险，然而，与文献数据一致，即使采用最新方法，该疾病的预后也无法得到显著改善。
