Acute Necrotizing Pancreatitis and Severe Hepatic Failure: Description of Three Cases

Abstract Introduction Acute pancreatitis is not uncommon in fulminant hepatic failure (FHF) as confirmed by histology or serology. A few reports exist of symptomatic pancreatitis in the setting of acute viral hepatitis; the diagnosis is usually made intraoperatively or postmortem. We report three ca...

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Bibliographic Details
Published in:Transplantation proceedings 2008-11, Vol.40 (9), p.3117-3120
Main Authors: Bernal Monterde, V, Campillo Arregui, A, Sostres Homedes, C, García Gil, A, Simón Marco, M.A, Serrano Aulló, M.T
Format: Article
Language:English
Subjects:
Biological and medical sciences
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Liver Failure - etiology
Liver Failure - surgery
Liver Transplantation - methods
Liver Transplantation - physiology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Pancreatitis, Acute Necrotizing - complications
Retrospective Studies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tissue, organ and graft immunology
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Summary:Abstract Introduction Acute pancreatitis is not uncommon in fulminant hepatic failure (FHF) as confirmed by histology or serology. A few reports exist of symptomatic pancreatitis in the setting of acute viral hepatitis; the diagnosis is usually made intraoperatively or postmortem. We report three cases of liver transplant (OLT) recipients with severe acute liver failure and severe acute pancreatitis as an intraoperative finding. Methods We undertook a retrospective review among a large cohort of liver transplant recipients to define the impact of this problem. Results Between 1999 and 2007, 293. LTs were performed including 15 (5%) who had severe acute liver failure (nine with FHF and six with an emergency retransplantation [ER]). Among this group, three patients were diagnosed intraoperatively with acute necrotizing pancreatitis (ANP): two patients with associated FHF and one with an ER due to ABO incompatibility. None of the patients had symptoms of pancreatitis. In all, ANP was classified as Balthazar CT grade D-E, which determined the outcome. All the patients developed a pseudocyst and abscess, which required surgical drains. Conclusion ANP was diagnosed as an intraoperative finding in patients with FHF. The mechanism of pancreatitis in patients with FHF is unknown. It may be multifactorial (virus, acute liver failure, hypotension, infection, drug-induced lesion,). This association leads to a worse outcome due to the complications.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2008.09.019