F interest to declare.
Fontana and Cappelli BMC Nephrology (2016) 17:163 DOI 10.1186/s
F interest to declare.
Fontana and Cappelli BMC Nephrology (2016) 17:163 DOI ten.1186/s12882-016-0376-CASE REPORTOpen AccessAcute pancreatitis connected with everolimus just after kidney transplantation: a case reportFrancesco Fontana and Gianni CappelliAbstractBackground: Acute pancreatitis (AP) following KT can be a uncommon and frequently fatal complication with the early post-transplant period. Popular causative components for AP are rare after KT; anti-rejection drugs as CyA, prednisone and MMF happen to be implicated, while evidence isn’t strong and we discovered no reports on doable causative role for mTOR inhibitors. Case presentation: A 55-year-old Caucasian man with end-stage renal disease because of idiopathic membranoprolipherative glomerulonephritis underwent single kidney transplantation (KT) from cadaveric donor. Anti-rejection protocol was according to Basiliximab induction followed by prednisone and mycophenolate mophetil (MMF) and Cyclosporine; Everolimus (Eve) was scheduled to substitute MMF at week three. At day 1 he had an asymptomatic elevation of pancreatic enzymes, spontaneously resolved. The additional course was unremarkable and on day 19 he started Eve, with following asymptomatic rise in pancreatic enzymes. At day 33 the patient presented with abdominal pain in addition to a TL1A/TNFSF15, Mouse (Biotinylated, HEK293, His-Avi) marked elevation in serum amylase (1383 U/l) and lipase (1015 U/l), regular liver enzymes and bilirubin, no hypercalcemia, mild elevation in triglycerids; RT-PCRs for Cytomegalovirus or Epstein-Barr virus had been damaging. The patient had no history of alcohol abuse; ultrasound, CT and MRI discovered no evidence of biliary lithiasis. CT scans showed a patchy fluid collection in the pancreatic head area, consistent with idiopathic necrotizing pancreatitis. The patient was treated medically and Eve was withdrawn 1 week following. Patient underwent guided drainage with the fluid collection, but created bacterial sepsis; surgical intervention was required with debridement of necrotic tissue, lavage and drainage; LacI, E.coli (His) immunosuppression was completely withdrawn. Following course was difficult with many systemic infection. Transplantectomy for acute rejection was performed, and patient entered hemodialysis. Conclusions: Our patient had a presentation that is consistent for a causative role of Eve. A predisposing situation (acute pancreatic insult through transplant surgery) spontaneously resolved, relapsed and evolved swiftly in AP right after the initiation of treatment with Eve with a constant time latency. None of the well-known common causative aspects for AP was present. We discourage the use of Eve in patients with recent episodes of sub-clinical pancreatitis, due to the fact it might represent a precipitating aspect or interfere with resolution. Keywords and phrases: Everolimus, Acute pancreatitis, Kidney transplantation, Case report Correspondence: [email protected] Surgical, Health-related and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, ItalyThe Author(s). 2016 Open Access This short article is distributed under the terms with the Creative Commons Attribution four.0 International License (://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) as well as the source, give a link towards the Inventive Commons license, and indicate if adjustments have been made. The Creative Commons Public Domain Dedication waiver (://creativecommons.org/publicdomain/zero/1.0/) app.