Background: Acute pancreatitis (AP) following KT is a rare and often fatal complication of the early post-transplant\nperiod. Common causative factors for AP are rare after KT; anti-rejection drugs as CyA, prednisone and MMF have\nbeen implicated, although evidence is not strong and we found no reports on possible causative role for mTOR\ninhibitors.\nCase presentation: A 55-year-old Caucasian man with end-stage renal disease due to idiopathic membranoprolipherative\nglomerulonephritis underwent single kidney transplantation (KT) from cadaveric donor. Anti-rejection\nprotocol was based on Basiliximab induction followed by prednisone and mycophenolate mophetil (MMF) and\nCyclosporine; Everolimus (Eve) was scheduled to substitute MMF at week 3. At day 1 he had an asymptomatic\nelevation of pancreatic enzymes, spontaneously resolved. The further course was unremarkable and on day 19 he\nstarted Eve, with following asymptomatic rise in pancreatic enzymes. At day 33 the patient presented with\nabdominal pain and a marked elevation in serum amylase (1383 U/l) and lipase (1015 U/l), normal liver enzymes\nand bilirubin, no hypercalcemia, mild elevation in triglycerids; RT-PCRs for Cytomegalovirus or Epstein-Barr virus\nwere negative. The patient had no history of alcohol abuse; ultrasound, CT and MRI found no evidence of biliary\nlithiasis. CT scans showed a patchy fluid collection in the pancreatic head area, consistent with idiopathic\nnecrotizing pancreatitis. The patient was treated medically and Eve was withdrawn 1 week after. Patient underwent\nguided drainage of the fluid collection, but developed bacterial sepsis; surgical intervention was required with\ndebridement of necrotic tissue, lavage and drainage; immunosuppression was totally withdrawn. Following course\nwas complicated with multiple systemic infection. Transplantectomy for acute rejection was performed, and patient\nentered hemodialysis.\nConclusions: Our patient had a presentation that is consistent for a causative role of Eve. A predisposing condition\n(acute pancreatic insult during transplant surgery) spontaneously resolved, relapsed and evolved rapidly\nin AP after the initiation of treatment with Eve with a consistent time latency. None of the well-known\ncommon causative factors for AP was present. We discourage the use of Eve in patients with recent\nepisodes of sub-clinical pancreatitis, since it may represent a precipitating factor or interfere with resolution.
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