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Effect of calcineurin inhibitor on post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with liver transplantation: a propensity-matched cohort study

Korean Journal of Internal Medicine 2020년 35권 6호 p.1364 ~ 1370
오형철, Easler Jeffrey J., El Hajj Ihab I., Watkins James, Fogel Evan L., McHenry Lee, Sherman Stuart, 강현, Lehman Glen A.,
소속 상세정보
오형철 ( Oh Hyoung-Chul ) - Chung-Ang University College of Medicine Department of Internal Medicine
 ( Easler Jeffrey J. ) - Indiana University School of Medicine Division of Gastroenterology and Hepatology
 ( El Hajj Ihab I. ) - Indiana University School of Medicine Division of Gastroenterology and Hepatology
 ( Watkins James ) - Indiana University School of Medicine Division of Gastroenterology and Hepatology
 ( Fogel Evan L. ) - Indiana University School of Medicine Division of Gastroenterology and Hepatology
 ( McHenry Lee ) - Indiana University School of Medicine Division of Gastroenterology and Hepatology
 ( Sherman Stuart ) - Indiana University School of Medicine Division of Gastroenterology and Hepatology
강현 ( Kang Hyun ) - Chung-Ang University College of Medicine Department of Anesthesiology and Pain Medicine
 ( Lehman Glen A. ) - Indiana University School of Medicine Division of Gastroenterology and Hepatology

Abstract


Background/Aims: A calcineurin inhibitor may alter pancreatic function and inflammatory reaction. This study aimed to determine the possible pharmacologic effect of the calcineurin inhibitor, tacrolimus, on pancreatic function, and to determine its preventive effect on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in liver transplantation (LT) patients.

Methods: The serum amylase and lipase values before and after LT were compared. The frequency of post-ERCP pancreatitis was compared between non-LT and LT patients, using propensity score matching method.

Results: Median serum amylase values (normal range, 19 to 86 U/L) were 49.0 U/L (38.0 to 68.0) before LT and 27.0 U/L (19.3 to 36.8) after LT, and median serum lipase values (normal range, 7 to 59 U/L) were 40.0 U/L (26.5 to 54.0) before LT and 10.5 U/L (6.0 to 21.0) after LT. Both serum amylase and lipase values significantly decreased after LT (p < 0.001), and to a level comparable to chronic pancreatitis. There was a marginal significant difference between the non-LT and LT groups before the propensity score matching with respect to frequency of post-ERCP pancreatitis (16 [3.2%] in non-LT group vs. 2 [0.9%] in LT group, p = 0.069). After propensity score matching, a marginal significant difference still existed with respect to frequency of post-ERCP pancreatitis (7 [4.8%] in non-LT group vs. 1 [0.7%] in LT group, p = 0.067).

Conclusions: The immunosuppression with calcineurin inhibitor may reduce not only the pancreatic enzyme dynamics but also inciting inflammatory event including post-ERCP pancreatitis.

키워드

Cholangiopancreatography, endoscopic retrograde; Pancreatitis; Liver transplantation; Calcineurin inhibitos

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