Camargo C A, Greig P D, Levy G A, Clavien P A
Multiorgan Transplantation Program, University of Toronto, Ontario, Canada.
J Am Coll Surg. 1995 Sep;181(3):249-56.
Acute pancreatitis (AP) has not been recognized as a frequent complication following orthotopic liver transplantation (OLT). Reports have suggested that this condition is associated with high morbidity and mortality rates.
A retrospective review of 354 patients who underwent OLT at the University of Toronto, with at least one-year follow-up, was done to identify the incidence, etiology, risk factors, and severity of pancreatitis following OLT, as well as to discuss its management. A possible correlation between AP and hepatitis B was also investigated. Prognostic score systems, including Ranson, Imrie, and APACHE II, were also evaluated.
Acute pancreatitis occurred in 5.9 percent of the OLT recipients. Based on clinical presentation and diagnostic tests, AP could be subdivided into three distinct categories: biochemical AP, significant increase of serum amylase or lipase levels in absence of objective radiologic or surgical evidence of the disease; clinical AP, pancreatitis with radiologic or surgical evidence of the disease; and AP in the critically ill patient. Biochemical AP occurred in the early postoperative period and was consistently a benign condition. Clinical AP occurred after a delay and was associated with a 40 percent mortality rate. Acute pancreatitis in the critically ill patient was only one component of multiorgan failure, which was lethal in each case. About one-half of the patients with biochemical and clinical AP were hepatitis surface antigen positive prior to OLT. The incidence of AP was significantly higher in patients with hepatitis B (17 percent) than in patients without hepatitis B (3 percent) (p < 0.01). APACHE II was the best prognostic score system in the clinical group with a positive and negative predictive value for a score equal to or greater than 10 points of 67 and 100 percent, respectively.
Acute pancreatitis is not an uncommon complication of OLT. Clinical presentation and diagnostic tests have important prognostic values. In some patients, hepatitis B virus may play an important role. APACHE II scores appear to be useful in the evaluation of clinical AP following OLT. Treatment of AP should be similar in both the transplant and nontransplant setting.
急性胰腺炎（AP）尚未被视为原位肝移植（OLT）后常见的并发症。报告表明，这种情况与高发病率和死亡率相关。
对在多伦多大学接受OLT且至少随访一年的354例患者进行回顾性研究，以确定OLT后胰腺炎的发病率、病因、危险因素和严重程度，并讨论其治疗方法。还研究了AP与乙型肝炎之间可能存在的相关性。同时评估了包括兰森、伊姆里和急性生理与慢性健康状况评分系统II（APACHE II）在内的预后评分系统。
5.9%的OLT受者发生了急性胰腺炎。根据临床表现和诊断测试，AP可分为三个不同类别：生化性AP，血清淀粉酶或脂肪酶水平显著升高，但缺乏该疾病的客观影像学或手术证据；临床AP，伴有该疾病影像学或手术证据的胰腺炎；以及危重症患者的AP。生化性AP发生在术后早期，且一直是良性情况。临床AP在术后延迟出现，死亡率为40%。危重症患者的急性胰腺炎只是多器官功能衰竭的一个组成部分，在每种情况下都是致命的。约一半生化性和临床AP患者在OLT前乙型肝炎表面抗原呈阳性。乙型肝炎患者中AP的发病率（17%）显著高于无乙型肝炎患者（3%）（p<0.01）。在临床组中，APACHE II是最佳的预后评分系统，评分等于或大于10分时，阳性预测值和阴性预测值分别为67%和100%。
急性胰腺炎是OLT并非罕见的并发症。临床表现和诊断测试具有重要的预后价值。在某些患者中，乙型肝炎病毒可能起重要作用。APACHE II评分似乎有助于评估OLT后的临床AP。AP的治疗在移植和非移植情况下应相似。
