Effect of calcineurin inhibitor on post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with liver transplantation: a propensity-matched cohort study.
Calcineurin inhibitos
Cholangiopancreatography, endoscopic retrograde
Liver transplantation
Pancreatitis
Journal
The Korean journal of internal medicine
ISSN: 2005-6648
Titre abrégé: Korean J Intern Med
Pays: Korea (South)
ID NLM: 8712418
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
28
12
2019
accepted:
04
01
2020
pubmed:
19
2
2020
medline:
23
6
2021
entrez:
19
2
2020
Statut:
ppublish
Résumé
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. 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. 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). The immunosuppression with calcineurin inhibitor may reduce not only the pancreatic enzyme dynamics but also inciting inflammatory event including post-ERCP pancreatitis.
Sections du résumé
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).
CONCLUSION
The immunosuppression with calcineurin inhibitor may reduce not only the pancreatic enzyme dynamics but also inciting inflammatory event including post-ERCP pancreatitis.
Identifiants
pubmed: 32066219
pii: kjim.2019.444
doi: 10.3904/kjim.2019.444
pmc: PMC7652662
doi:
Substances chimiques
Calcineurin Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1364-1370Références
Gastrointest Endosc. 2007 Mar;65(3):385-93
pubmed: 17321236
Liver Transpl. 2013 Dec;19(12):1354-60
pubmed: 24115362
Lancet. 2016 Jun 4;387(10035):2293-2301
pubmed: 27133971
Stat Med. 2008 May 30;27(12):2037-49
pubmed: 18038446
Scand J Surg. 2015 Jun;104(2):86-91
pubmed: 24737853
Gastroenterology. 2016 Aug;151(2):288-297.e4
pubmed: 27215656
Am J Physiol Gastrointest Liver Physiol. 2009 Nov;297(5):G967-73
pubmed: 20501444
Pancreas. 2016 Sep;45(8):1184-8
pubmed: 27482865
Gastrointest Endosc. 2003 Jul;58(1):23-9
pubmed: 12838216
Gastroenterology. 2016 Apr;150(4):911-7; quiz e19
pubmed: 26775631
Clin Transplant. 2016 Aug;30(8):901-11
pubmed: 27220013
J Gastroenterol. 2014 Feb;49(2):343-55
pubmed: 23612857
Transplant Proc. 2009 May;41(4):1319-21
pubmed: 19460551
Clin Gastroenterol Hepatol. 2007 Nov;5(11):1339-46
pubmed: 17981247
Pharmacoepidemiol Drug Saf. 2000 Mar;9(2):93-101
pubmed: 19025807
Am J Epidemiol. 2006 Jun 15;163(12):1149-56
pubmed: 16624967
Gut Liver. 2017 Nov 15;11(6):878-883
pubmed: 29081212
N Engl J Med. 2012 Apr 12;366(15):1414-22
pubmed: 22494121
Gastrointest Endosc. 2004 Jun;59(7):845-64
pubmed: 15173799
Gastrointest Endosc. 2002 Apr;55(4):470-5
pubmed: 11923756
Gastrointest Endosc. 1991 May-Jun;37(3):383-93
pubmed: 2070995
Gastrointest Endosc. 2011 Aug;74(2):285-94
pubmed: 21704993
Gastroenterology. 2015 Sep;149(3):753-64.e11
pubmed: 25980752