Kanjanahattakij Napatt, Lapumnuaypol Kamolyut, Fatima Sanna, Feyssa Eyob
Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
Department of Transplantation, Einstein Medical Center, Philadelphia, PA, USA.
Case Rep Transplant. 2017;2017:6047046. doi: 10.1155/2017/6047046. Epub 2017 Oct 22.
In general population, gallstone pancreatitis is the most common cause of pancreatitis. However, there are very few literatures that address this topic in post-liver-transplant patients.
A 69-year-old female who had a liver transplant in 2015 due to hepatocellular carcinoma and nonalcoholic steatohepatitis (NASH) cirrhosis. She had a recent episode of acute cellular rejection that was treated with high dose methylprednisolone 1 week prior to admission. She presented with severe epigastric abdominal pain associated with nausea and vomiting. Her laboratory studies showed significantly elevated serum lipase, AST, and ALT from her baseline. She underwent urgent Endoscopic Ultrasound (EUS) with Endoscopic Retrograde Cholangiopancreatography (ERCP) that showed common bile duct stone that was extracted.
Biliary sludge and stones accounted for 22% of late onset acute pancreatitis after liver transplant. Corticosteroids have been identified as one of the potential causes of drug-induced pancreatitis. However, she is more likely to have gall stone pancreatitis since she also had dilated common bile duct and intrahepatic duct. In addition, there was CBD stone noted on ERCP.
Acute gallstone associated pancreatitis after liver transplant is not uncommon. Patients generally have good outcomes. Further prospective studies are warranted.
在普通人群中，胆石性胰腺炎是胰腺炎最常见的病因。然而，针对肝移植术后患者这一主题的文献却非常少。
一名69岁女性，2015年因肝细胞癌和非酒精性脂肪性肝炎（NASH）肝硬化接受了肝移植手术。入院前1周，她近期发生了一次急性细胞排斥反应，接受了高剂量甲泼尼龙治疗。她因严重的上腹部腹痛伴恶心、呕吐就诊。实验室检查显示，与基线相比，她的血清脂肪酶、谷草转氨酶（AST）和谷丙转氨酶（ALT）显著升高。她接受了紧急内镜超声检查（EUS）及内镜逆行胰胆管造影（ERCP），结果显示胆总管结石并已取出。
胆泥和结石占肝移植术后迟发性急性胰腺炎的22%。皮质类固醇已被确定为药物性胰腺炎的潜在病因之一。然而，她更有可能患胆石性胰腺炎，因为她还存在胆总管和肝内胆管扩张。此外，ERCP检查发现了胆总管结石。
肝移植术后急性胆石相关性胰腺炎并不少见。患者总体预后良好。有必要进行进一步的前瞻性研究。
