Emergency surgical treatment of complicated acute pancreatitis after kidney transplantation with acute rejection: Case report and literature review

Immunosuppressant-induced late acute pancreatitis after laparoscopic sleeve gastrectomy: a case report and literature review

Acute pancreatitis (AP) is a serious life-threatening condition, especially in high-risk patients. Limited data exist regarding early and late complications of immunosuppressant drugs as a cause of pancreatitis, especially Tacrolimus and Mycophenolate Mofetil (MMF), after transplantation. We report a rare case of late AP secondary to immunosuppressants’ synergistic effect after 5 years of renal transplant in an obese patient on day 4 after laparoscopic sleeve gastrectomy (LSG). We present a 41-year-old Saudi obese male patient, known to have multiple comorbidities and a renal transplantation twice, was on multiple medications, including Prednisolone, MMF and Tacrolimus for 5 years. On day 4 post-LSG, he developed severe epigastric abdominal pain and was diagnosed to have AP as a late complication of immunosuppressants’ synergistic effect. LSG is a common safe procedure, but complications related to medical illnesses or medications can occur. Careful review and sufficient knowledge of early and late complications are required.

Defining the Burden of Emergency General Surgery in Transplant Patients: A Nationwide Examination

BACKGROUND

Transplant patients are at the risk of serious sequelae from medical and surgical intervention. The incidence and burden of emergency general surgery (EGS) in transplant patients are scarcely known. This study aims to identify predictors of outcomes in transplant patients with EGS needs.

METHODS

The Nationwide Inpatient Sample (2007-2011) was queried for adult patients (aged ≥16 y) who underwent abdominal visceral transplantation. These were further queried for a secondary diagnosis of an American Association for the Surgery of Trauma-defined EGS condition. Outcome measures included mortality, complications, length of stay, and cost of care. Propensity scores were used to match patients across baseline characteristics. Multivariate analysis was used to further adjust propensity score quintiles and hospital-level characteristics.

RESULTS

A total of 35,573 transplant patients were identified. Of these, 30% (n = 10,676) developed an EGS condition. Most common EGS conditions were resuscitation (7.7%), intestinal obstruction (7.3%), biliary conditions (3.9%), and hernias (3.2%). Patients with public insurance, those in the highest income quartile, and those treated at larger hospitals had a lower likelihood of developing an EGS condition (P < 0.05). Patients with an EGS condition had a ninefold higher likelihood of mortality and a threefold higher likelihood of developing complications (odds ratio [95% confidence interval (CI)]: 9.21 [1.80-10.89] and 3.17 [3.02-3.34], respectively). Transplant patients after EGS had a longer risk-adjusted length of stay and cost of index hospitalization (Absolute difference [95% CI]: 12.70 [12.14-13.26] and $57,797 [55,415-60,179], respectively]).

CONCLUSIONS

Transplant patients fare poorly after developing an EGS condition. The results of this study will help in identifying at-risk patients and determining outcomes.