rejection occurs in about half of the patients within 6 weeks after liver

Rejection occurs in about half of the patients within

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rejection occurs in about half of the patients within 6 weeks after liver transplantation, and acute rejection is reversed by large doses of steroids in most cases. Chronic rejection, on the other hand, is a different entity that is ill-understood and corresponds to destruction of small arteries and bile ducts. Change in the immunosuppression regimen sometimes may hinder the progression of this disease, but often retransplantation is required. 37. An elevated serum amylase level following pancreas-kidney transplantation may be due to: A. Preservation/procurement injury. B. Rejection. C. Reflux pancreatitis. D. Duodenal segment leak or bladder leak. E. Native pancreatitis. F. Constipation. Answer: ABDEF DISCUSSION: During the immediate postoperative period, an elevated serum amylase is usually due to preservation or procurement injury to the transplanted pancreas. If UW (University of Wisconsin) solution and a good flushout technique is used in an acceptable donor, amylase is usually elevated only several hundred points and will decline in a day or two. Rejection of the pancreas can also cause elevated serum amylase and is usually accompanied by a rise in the creatinine value due to concomitant renal transplant rejection. Reflux pancreatitis is generally caused by bladder dysfunction: increased pressure transmitted back through the pancreatic ducts causes pancreatitis. It is generally relieved by bladder decompression with a Foley catheter. Naturally, leakage from the anastomosis of the pancreas transplant to the bladder causes absorption of amylase from the peritoneal cavity and an elevated serum amylase value. Constipation causes a rise in the amylase level of pancreas-kidney transplant recipients, for reasons that remain unclear. Native pancreatitis has to be borne in mind in the differential diagnosis of hyperamylasemia in transplant patients. Contributing factors may include underlying gallbladder disease, as well as side effects of steroids and Imuran. 38. Complications of a pancreas transplant drained into the bladder include: DISCUSSION: All of the listed problems are potential complications of bladder drainage. The most useful diagnostic tests for a duodenal segment leak include CT cystogram and technetium-based nuclear cystogram. Cystoscopy should be performed in patients with recurrent urinary tract infections to evaluate the presence of sutures or foreign bodies acting as a nidus for infection. Severe recurrent hematuria, as well as urethritis (most commonly affecting males), may occur with bladder drainage. Finally, severe bicarbonate loss may be associated with bladder drainage, and some patients may have difficulty keeping up with the loss by oral bicarbonate replacement. All of the above situations can be effectively treated with enteric conversion
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  • Fall '18
  • The Iliad, consultant, Dr. Gharama Al-Shehri, Dr. Ghazi Al-Shumrani

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