Post-Implantation Graft Pancreatitis - Ischemic Pancreatitis
Graft pancreatitis in the early post-transplantation period is secondary to ischemia and dissolution of the cellular structures. This is related to and impairment of microcirculation in the reperfusion period. Grafts from older donors appear to have a higher probability to develop graft pancreatitis.
Ischemia-reperfusion injury not only plays an important role in the development of graft pancreatitis but also appears to be causally related to vascular thrombosis after pancreas transplantation. Massive thrombosis of large blood vessels is associated with extensive coagulation necrosis of the graft and rapid loss of graft function. On the other hand, thrombosis in small blood vessels is associated with patchy coagulation necrosis of acinar tissue. These findings may be subtle and do overlap with those of acute pancreatitis.
The morphology of post-transplant graft pancreatitis is similar to native pancreatitis. This consists of edema, infiltration by neutrophils, enzymatic fat necrosis, and enzymatic necrosis of parenchyma. The interlobular septa appear very edematous and expanded.
Benz S, Bergt S, Overmaier R, Wiessner R, Pfeffer F, Schareck W, Hop UT: Impairment of microcirculation in the early reperfusion period predicts the degree of graft pancreatitis in clinical pancreas transplantation. Transplantation 2001;71:759-63.
Grewal HP, Garland L, Novak K, Gaber L, Tolley EA, Gaber AO: Risk factors for post-implantation pancreatitis and pancreatic thrombosis in pancreas transplant recipients. Transplantation 1993;56:609-12.
Busing M, Hopt UT, Quacken M, Becker HD, Morgenroth K: Morphological studies of graft pancreatitis following pancreas transplantation. Br J Surg 1993;80:1170-3.
Benz S, Schnabel R, Morgenroth K, Weber H, Pfeffer F, Hopt UT: Ischemia /reperfusion injury of the pancreas: a new animal model. J Surg Res 1998;75:109-15.
Keck T, Banafsche R, Werner J, Gebhard MM, Herfarth C, Klar R: Desmopressin impairs microcirculation in donor pnacreas and early graft function after experimental pancreas transplantation. Transplantation 2001;72:202-9.
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