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 [PMID: 38464928 DOI: 10.12998/wjcc.v12.i6.1104]
Corresponding Author of This Article
Nikolina Basic-Jukic, MD, PhD, Professor, Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, No. 12 Kišpatićeva, Zagreb 10000, Croatia. nina_basic@net.hr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 26, 2024; 12(6): 1104-1110 Published online Feb 26, 2024. doi: 10.12998/wjcc.v12.i6.1104
Acute pancreatitis as a complication of acute COVID-19 in kidney transplant recipients
Nikolina Basic-Jukic, Ivana Juric, Lea Katalinic, Vesna Furic-Cunko, Vibor Sesa, Anna Mrzljak
Nikolina Basic-Jukic, Ivana Juric, Lea Katalinic, Vesna Furic-Cunko, Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Nikolina Basic-Jukic, Anna Mrzljak, Department of Medicine, School of Medicine, Zagreb 10000, Croatia
Vibor Sesa, Anna Mrzljak, Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Author contributions: Basic-Jukic N was involved in conceptualization of the study; Juric I, Katalinic L, Furic-Cunko V were responsible for data curation; Juric I and Katalinic L drafted the original version of the manuscript; Basic-Jukic N, Furic-Cunko V, Mrzljak A and Sesa V reviewed and edited the manuscript. All authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethic Committee of University Hospital Centre Zagreb (Approval No. 8.1-21/252-2).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at: nina_basic@net.hr.Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolina Basic-Jukic, MD, PhD, Professor, Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, No. 12 Kišpatićeva, Zagreb 10000, Croatia. nina_basic@net.hr
Received: December 7, 2023 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 Processing time: 74 Days and 14.7 Hours
Abstract
BACKGROUND
Acute pancreatitis is a rare extrapulmonary manifestation of coronavirus disease 2019 (COVID-19) but its full correlation with COVID-19 infection remains unknown.
AIM
To identify acute pancreatitis’ occurrence, clinical presentation and outcomes in a cohort of kidney transplant recipients with acute COVID-19.
METHODS
A retrospective observational single-centre cohort study from a transplant centre in Croatia for all adult renal transplant recipients with a functioning kidney allograft between March 2020 and August 2022 to record cases of acute pancreatitis during acute COVID-19. Data were obtained from hospital electronic medical records. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was proven by a positive SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction on the nasopharyngeal swab.
RESULTS
Four hundred and eight out of 1432 (28.49%) patients who received a renal allograft developed COVID-19 disease. The analyzed cohort included 321 patients (57% males). One hundred and fifty patients (46.7%) received at least one dose of the anti-SARS-CoV-2 vaccine before the infection. One hundred twenty-five (39.1%) patients required hospitalization, 141 (44.1%) developed pneumonia and four patients (1.3%) required mechanical ventilation. Treatment included immunosuppression modification in 233 patients (77.1%) and remdesivir in 53 patients (16.6%), besides the other supportive measures. In the study cohort, only one transplant recipient (0.3%) developed acute pancreatitis during acute COVID-19, presenting with abdominal pain and significantly elevated pancreatic enzymes. She survived without complications with a stable kidney allograft function.
CONCLUSION
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.
