Pancreatic pseudocyst formation following renal transplantation: A lethal development

In this retrospective study, extending from 1 January 1972 to 30 June 1988, we identified 10 patients who had pancreatitis and who developed pancreatic pseudocysts out of 1177 patients receiving renal transplants. Two patients had complete spontaneous resolution of their pseudocysts over 25 and 30 days of observation, while the remainder required operative intervention. Standard internal drainage was possible in only 1 of the 8 operated patients. This patient was followed with serial CT scans for more than 100 d prior to exploration. The remaining 7 patients had either thin cyst walls (N = 3) or infected cysts (N = 4) at operation (mean period of preoperative observation 36.5 d for thin-walled cysts, 39 d for infected cysts) and therefore received external drainage. There were seven major complications in these 10 patients: 2 patients developed massive intraabdominal bleeding from splenic artery erosions, 1 had spontaneous rupture of a pancreatic pseudocyst, 1 patient developed a colocutaneous fistula, and 3 lost graft function. Overall mortality was 50%. Severe pancreatitis, sepsis, and multiple organ failure was the cause of death in 4 out of 5 deaths. Transplant recipients who develop pancreatitis and pancreatic pseudocysts should be managed with reduction of immunosuppressive therapy to maintenance levels, close observation for signs of sepsis and immediate aggressive management once this is present. In the stable patient, elective internal cyst drainage may not be possible until later than in the non-immunosuppressed patient. This study represents the largest reported series of patients with pancreatic pseudocysts following renal transplantation and confirms the ominous nature of this complication in renal transplant recipients.