Published online Feb 26, 2024. doi: 10.12998/wjcc.v12.i6.1104
Peer-review started: December 7, 2023
First decision: December 17, 2023
Revised: December 18, 2023
Accepted: January 31, 2024
Article in press: January 31, 2024
Published online: February 26, 2024
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Acute pancreatitis is a rare extrapulmonary manifestation of coronavirus disease 2019 (COVID-19) but its full correlation with COVID-19 infection remains un
To identify acute pancreatitis’ occurrence, clinical presentation and outcomes in a cohort of kidney transplant recipients with acute COVID-19.
A retrospective observational single-centre cohort study from a transplant centre in Croatia for all adult renal transplant recipients with a functioning kidney allo
Four hundred and eight out of 1432 (28.49%) patients who received a renal allo
Although rare, acute pancreatitis may complicate the course of acute COVID-19 in kidney transplant recipients. The mechanism of injury to the pancreas and its correlation with the severity of the COVID-19 infection in kidney transplant recipients warrants further research.
Core Tip: The attention to the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus on pancreatic tissue has been arising. It is hypothesized that the SARS-CoV-2 virus can directly affect pancreatic tissue via angiotensin-converting enzyme 2 receptors which are heavily expressed in pancreatic cells. Our single-centre retrospective study aimed to identify the occurrence of acute pancreatitis, clinical presentation and outcomes in a cohort of kidney transplant recipients with acute coronavirus disease 2019 (COVID-19) between March 2020 and August 2022. 28.49% of transplant recipients developed COVID-19 disease and only 0.3% developed acute pancreatitis during the acute COVID-19 presenting with abdominal pain and elevated pancreatic enzymes with no imaging features. The mechanism of injury to the pancreas and its correlation with the severity of the COVID-19 infection in kidney transplant recipients warrants further research.
- Citation: Basic-Jukic N, Juric I, Katalinic L, Furic-Cunko V, Sesa V, Mrzljak A. Acute pancreatitis as a complication of acute COVID-19 in kidney transplant recipients. World J Clin Cases 2024; 12(6): 1104-1110
- URL: https://www.wjgnet.com/2307-8960/full/v12/i6/1104.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v12.i6.1104
Acute pancreatitis is an acute inflammation of the pancreas characterized by typical upper abdominal pain, vomiting and nausea. Clinical, biochemical and/or radiologic findings are required to establish a diagnosis[1]. The most common cau
A retrospective observational single-centre cohort study recruited study participants from the largest kidney transplant centre in Croatia to record cases of acute pancreatitis during acute COVID-19 infection. Data were retrospectively ob
SARS-CoV-2 infection was proven by a positive SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) on the nasopharyngeal swab. No data on SARS-CoV-2 genotyping were available.
The diagnosis of acute pancreatitis was based on the fulfilment of two of three criteria: (1) Upper abdominal pain; (2) serum amylase and/or lipase of at least three times the upper limit of normal; and/or (3) findings consistent with acute pancreatitis on imaging studies (abdominal ultrasound, computed tomography or magnetic resonance imaging)[1]. The study was approved by the University Hospital Center Zagreb Ethics committee.
In the study period, 408 out of 1432 (28.49%) patients who received a renal allograft at our institution developed COVID-19 disease, proved by the positive SARS-CoV-2 RT-PCR on the nasopharyngeal swab. Twenty-five patients died in the period during or after the infection and 62 patients had not been assessed in our clinic and were therefore excluded from the study population, which finally included 321 patients (57% males) (Table 1). One hundred and fifty patients (46.7%) received at least one dose of the anti-SARS-CoV-2 vaccine before the infection. Regarding the severity of SARS-COV-2 infection, 21 (6.6%) patient was completely asymptomatic, while 125 (39.1%) patients required hospitalization, 141 (44.1%) developed pneumonia and 4 patients (1.3%) required mechanical ventilation. The most common presenting symptom was febrility (76.6%), followed by respiratory symptoms (71.9%) and diarrhoea (12.2%).
Characteristics | Number (%) of patients | Range |
Sex | ||
Male/female | 183/138 (57/43) | |
Age (yr) [Median (IQR)] Primary kidney disease | 55 (44-64) | 22-81 |
Glomerulonephritis | 9 + 8 (30.6) | |
Diabetic nephropathy | 12 (3.8) | |
ADPKD | 48 (15) | |
Pyelonephritis | 26 (8.1) | |
Nephroangiosclerosis | 26 (8.1) | |
Other | 110 (34.4) | |
Time from transplantation (months) [Median (IQR)] | 94.5 (52-135.8) | 1-368 |
Height (cm) [Median (IQR)] | 171 (163-180) | 124-199 |
Body weight (kg) [Median (IQR)] | 79 (67-92) | 42-150 |
BMI [Median (IQR)] | 26.5 (23.9-29.2) | 17.36-45.79 |
Nutritional status | ||
Underweight (BMI < 18.5) | 4 (1.3) | |
Normal weight | 105 (32.8) | |
Pre-obesity (25-29.9) | 144 (45) | |
Obese (≥ 30) | 67 (20.9) | |
Previous thrombosis | 30 (9.4) | |
Previous myocardial infarction or stroke | 32 (10) | |
Previous CMV infection | 36 (11.3) | |
Previous BK infection | 68 (21.3) | |
Previous EBV infection | 28 (8.8) | |
Allograft rejection | 46 (14.4) | |
Creatinine value [Median (IQR)] | 129 (98-165.8) | 45-430 |
CKD EPI [Median (IQR)] | 49 (35-64) | 0.23-133 |
Biuret [Median (IQR)] | 0.2 (0.1-0.5) | 0-79 |
Vaccinated against COVID-19 | 246 (76.9) | |
Before COVID-19 infection | 149 (46.6) | |
After COVID-19 infection | 97 (30.3) | |
Number of vaccine doses [Median (IQR)] | 2 (2-3) | 1-4 |
Number of vaccine doses (n = 246) | ||
One | 21 (8.5) | |
Two | 138 (56.1) | |
Three | 83 (33.7) | |
Four | 4 (1.6) | |
COVID-19 initial symptoms | ||
Febrility | 245 (76.6) | |
Diarrhea | 39 (12.2) | |
Respiratory | 230 (71.9) | |
Asymptomatic | 21 (6.6) | |
COVID-19 initial complications | ||
Hospitalisation | 125 (39.1) | |
Pneumonia | 141 (44.1) | |
Mechanical ventilation | 4 (1.3) | |
Other | 66 (20.6) | |
Initial immunosuppression | ||
Tacrolimus | 222 (69.4) | |
Cyclosporin A | 70 (21.9) | |
Mycophenolate | 280 (87.5) | |
Azathioprine | 12 (3.8) | |
Everolimus | 48 (15) | |
Prednisolone (dose) [Median (IQR)] | 5 (5-5) | 0-30 |
Acute COVID-19 treatment | ||
Cessation of MMF/Aza | 133 (41.6) | |
Decreasing MMF/Aza | 102 (31.9) | |
Cessation of Tac/CyA | 1 (0.3) | |
Decreasing Tac/CyA | 29 (9.1) | |
Hyperimmune anti-CMV globulin | 30 (9.4) | |
Intravenous immunoglobulin | 13 (4.4) |
Treatment included immunosuppression modification in 233 patients (77.1%) and remdesivir in 53 patients (16.6%), besides the other supportive measures. Additionally, thirteen patients (4.4%) received intravenous immunoglobulins, eight (2.5%) received convalescent plasma and 30 patients (9.4%) received hyperimmune anti- cytomegalovirus (CMV) globulin (in exchange for convalescent plasma) as a passive immune augmentation. Three patients (0.9%) were treated with tocilizumab. In the study cohort only one patient (0.3%) developed acute pancreatitis during acute COVID-19.
A 68-year-old female with a kidney allograft from a deceased donor 127 months ago due to end-stage renal disease cau
Treatment included hydration, broad-spectrum antibiotics, proton pump inhibitors and low molecular weight heparin with temporary cessation of mycophenolate. She recovered entirely without complications with a stable allograft func
Our retrospective analysis shows that acute pancreatitis in a COVID-19 setting is a rare (0.3%) complication in kidney transplant recipients. Data on the transplant population are scarce and are based only on a few case reports from which no data about the incidence and characteristics of this specific group of patients can be extracted[7].
Also, in a non-COVID-19 setting, acute pancreatitis is rare after kidney transplantation and is mainly associated with the use of steroids and other immunosuppressive drugs[8] without traditional risk factors like gallstones and alcohol con
During acute SARS-CoV-2 infection, acute pancreatitis was diagnosed in only one kidney transplant recipient from our cohort. Current guidelines recommend monitoring the presence of systemic inflammatory response syndrome or organ failure at admission for a minimum of 48 h to predict the development of a severe course of the disease[1]. Her symptoms were present at the hospital admission; however the three-week history disables precise determination of the timing bet
In the non-transplant population, the literature demonstrates cases of acute pancreatitis at COVID-19's initial presen
A growing body of evidence reveals the relationship between SARS-CoV-2 infection and acute pancreatitis[12,16]. The virus has been isolated from the pancreatic pseudocyst of a patient with acute pancreatitis[17]. The receptor theory sug
Besides potential direct and indirect viral effects, antiviral drugs may induce pancreatic lesions. For example, remde
Our immunocompromised patient had two out of three criteria for acute pancreatitis. Typical clinical presentation and laboratory findings without radiological changes indicate serous pancreatitis that may be viral aetiology.
Similar to our experience, Kumar et al[21] report that patients with acute pancreatitis on admission had a better clinical outcome when compared to patients who developed acute pancreatitis during hospitalization for acute COVID-19.
Our study has several limitations, mainly due to the retrospective nature of this study. We are missing data for 25 tr
The incidence of acute pancreatitis in the COVID-19 setting in the transplant population is low. However, the mechanism of injury to the pancreas and its correlation with the severity of the COVID-19 infection in kidney transplant recipients warrants further research.
Acute pancreatitis, an infrequent extrapulmonary manifestation of coronavirus disease 2019 (COVID-19), raises uncer
No prior literature explores the occurrence of acute pancreatitis in the kidney transplant population in the context of COVID-19.
To describe the occurrence, clinical presentation and outcomes of acute pancreatitis in a cohort of kidney transplant re
A retrospective observational single-center cohort study conducted at a single transplant center in Croatia, encompassing all adult renal transplant recipients with a functioning kidney allograft between March 2020 and August 2022. Data, in
Out of 1432 renal allograft recipients, 28.49% developed COVID-19. Hospitalization was necessary for 39.1% of patients, with 44.1% developing pneumonia and 1.3% requiring mechanical ventilation. Treatment involved immunosuppression modification in 77.1% and remdesivir in 16.6%, alongside other supportive measures. Acute pancreatitis occurred in one transplant recipient (0.3%). The patient recovered without complications, maintaining stable kidney allograft function.
Although uncommon, acute pancreatitis may complicate the course of acute COVID-19 in kidney transplant recipients.
Further research is warranted to explore the mechanism of pancreatic injury and its correlation with the severity of COVID-19 infection in kidney transplant recipients.
Provenance and peer review: Invited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Medicine, research and experimental
Country/Territory of origin: Croatia
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P-Reviewer: Gong F, China S-Editor: Qu XL L-Editor: A P-Editor: Xu ZH
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