Tissières P, Simon L, Debray D, Branchereau S, Soubrane O, Gauthier F, Devictor D
Unité de Soins Intensifs, Département de Pédiatrie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
J Pediatr Gastroenterol Nutr. 1998 Mar;26(3):315-20. doi: 10.1097/00005176-199803000-00014.
Acute pancreatitis after orthotopic liver transplantation is a well-known complication in adults that has never been described in children. In adults, end-stage liver disease related to hepatitis B, intraoperative pancreatic injury caused by extensive peripancreatic dissection, the type of biliary anastomosis performed, and numerous drugs, have all been described as predisposing factors in acute pancreatitis after liver transplantation. The current retrospective review was undertaken to identify the incidence, the contributing factors, and the outcome of acute pancreatitis after liver transplantation in children.
During a 10-year period, 375 children underwent 434 liver transplantations in the authors' institution. In seven patients (1.9%), clinical acute pancreatitis developed after orthotopic liver transplantation. Indication for initial liver transplantation was biliary atresia (n = 3), acute liver failure (n = 3), and type 1 Crigler-Najjar syndrome. In all seven patients, liver graft function was initially adequate. The diagnosis of acute pancreatitis was based on clinical, biochemical, ultrasonographic, and surgical signs.
In six patients, acute pancreatitis appeared within the first week after transplantation. The diagnosis was confirmed by abdominal laparotomy in five children. In the current series, emergency liver transplantation (p < 0.001), retransplantations (p < 0.001), and infectious peritonitis (p < 0.001) were contributing factors. Despite supportive measures, three patients died (43%) because of multiple organ dysfunction syndrome.
Acute pancreatitis is an uncommon but life-threatening complication after liver transplantation in children. Early diagnosis and aggressive treatment of infectious complications are major elements in the management of acute pancreatitis after liver transplantation.
原位肝移植术后急性胰腺炎是成人中一种广为人知的并发症，但从未在儿童中被描述过。在成人中，与乙型肝炎相关的终末期肝病、胰腺周围广泛解剖导致的术中胰腺损伤、所进行的胆道吻合类型以及多种药物，均被描述为肝移植术后急性胰腺炎的诱发因素。本项回顾性研究旨在确定儿童肝移植术后急性胰腺炎的发病率、相关因素及预后。
在10年期间，作者所在机构的375名儿童接受了434例肝移植手术。7例患者（1.9%）在原位肝移植术后发生了临床急性胰腺炎。初次肝移植的指征为胆道闭锁（n = 3）、急性肝衰竭（n = 3）和1型克里格勒 - 纳贾尔综合征。所有7例患者的肝移植肝功能最初均正常。急性胰腺炎的诊断基于临床、生化、超声及手术体征。
6例患者在移植后第一周内出现急性胰腺炎。5例儿童通过腹部剖腹术确诊。在本系列研究中，急诊肝移植（p < 0.001）、再次移植（p < 0.001）和感染性腹膜炎（p < 0.001）是相关因素。尽管采取了支持性措施，仍有3例患者（43%）因多器官功能障碍综合征死亡。
急性胰腺炎是儿童肝移植术后一种罕见但危及生命的并发症。早期诊断和积极治疗感染性并发症是肝移植术后急性胰腺炎管理的主要要素。
