Abstracts
1998 Digestive Disease Week

#1016

ACUTE PANCREATITIS FOLLOWING CARDIAC TRANSPLANT-ATION IS SIGNIFICANTLY INCREASED COMPARED WITH OTHER CARDIAC PROCEDURES. AJ Herline, J Debelak, CW Pinson, D Harley, W Merrill, T Starkey, R Pierson, WC Chapman. Departments of Surgery and Cardiothoracic Surgery, Vanderbilt University Medical Center and St. Thomas Hospital, Nashville, TN.

Introduction: Previous reports indicate that cardiac transplantation or coronary/valve surgery carries an increased risk for post-operative acute pancreatitis compared with other types of surgery. Mortality has been reported to range from 9-100% in small transplant series.

Design: Inception-cohort comparison survey.

Patients: We conducted an analysis of all adult patients undergoing cardiopulmonary bypass (CPB) from April, 1985 to June, 1996.

Main outcome measures: Patients developing clinically significant pancreatitis were analysized for etiologic risk factors (CPB, intra-aortic balloon, low cardiac output, immunosuppression, infection, cholelithiasis, hypocalcemia, prior pancreatitis), APACHE II data, and outcome.

Results: Twelve (3.0%) of 394 patients who underwent cardiac transplantation and 27 (0.11%) of 24,237 patients who underwent non-transplant CPB developed pancreatitis (p_0.001). APACHE II scores were 21.0 ± 1.4 after transplantation vs. 17.7 ± 1.1 after nontransplant CPB. In the cardiac transplant group, there was 3.2 ± 0.3 risk factors for pancreatitis vs. 1.9 ± 0.1 in the non-transplant CPB group (p_0.001). Similar rates of operative intervention were required in the two groups. Mortality was 33% in patients with pancreatitis after transplantation vs. 14% in patients with pancreatitis after non-transplant CPB.

Conclusions: There is a 25-fold increase in incidence of pancreatitis after cardiac transplantation than after non-transplant CPB. Analysis of risk factors indicates this is primarily due to the additional risk of immunosuppression.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.