Journal Article

26 Outcomes of Acute Pancreatitis in Liver Transplant Patients. A Nationwide Readmission Database Analysis

Chahal, Prabhleen, Saad, Anas, Gad, Mohamed, Saleh, Mohannad Abou, Simons-Linares, Roberto

2019

Overview

INTRODUCTION:Acute pancreatitis (AP) is a well-recognized and generally serious complication following liver transplantation. We sought to assess AP following adult liver transplantation to describe the risk factors, natural history of the disease and outcomes.METHODS:Data from Nationwide Readmission database from 2010 to 2015 was analyzed. All adult patients who were hospitalized for a primary diagnosis of acute pancreatitis were identified and patients who had a history of liver transplantation were compared to patients with no transplantation, using the appropriate ICD 9 codes. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages. All statistical tests were two-sided.RESULTS:1,575,148 AP patients were included, and out of those 1581 patients (0.1%) had a history of liver transplantation. Patients with a history of transplantation had higher rates of hypertension 59.1% vs. 53.8%, P-value < 0.001, uncomplicated diabetes mellitus, 32.6% vs. 22.9%, P-value < 0.001, diabetes mellitus with chronic complications, 5.8% vs. 3.8%, P-value < 0.001, chronic pancreatitis, 18.2% vs. 16.1%, P-value = 0.02, chronic renal failure 39.6% vs. 7.9%, P-value < 0.001. Transplant patients had higher rates of in-hospital AP complications: acute kidney injury 20.3% vs. 8.3%, P-value < 0.001, transfusion requirement 7.2% vs. 3.0%, P-value < 0.001. No significant difference in the rates of systemic inflammatory response syndrome (SIRS), 2.1% vs. 2.1%, P-value = 0.929, or ileus, 4.0% vs. 3.7%, P-value = 0.595. Transplant patients had lower rates of acute respiratory distress syndrome and/or ventilation need, 0.6% vs. 2.3%, P-value < 0.001, and sepsis 0.5% vs. 1.6%, P-value < 0.001. In-hospital mortality was higher in patients with history of liver transplantation 0.8%vs. 0.3%, P-value = 0.053. Median length of stay was not significantly different 3.00 (2–6) days vs. 3.00 (2–5), P-value = 0.17. Charges of hospitalization were significantly higher in the transplantation group 23,615 USD vs. 21,020 USD, P-value < 0.001.CONCLUSION:Post-liver transplant AP carries significant morbidity and mortality. The extensive nature of the anatomical dissection around the pancreas, the type of biliary reconstruction and anastomosis, chronic immunosuppression medications, associated comorbidities, could be contributing factors. Our study highlights possible areas for further investigation in the liver transplant population.

• Publisher: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subject: Diabetes / Liver transplants / Mortality / Pancreatitis