Background: Acute pancreatitis(AP) following liver transplantation(LT) is a rare but fatal complication, that carries significant morbidity and mortality. There are no published guidelines on how to manage these patients. Herein, we present two cases of LT recipients, who developed AP early after cadaveric LT to explore the etiology and management of AP in these patients.  Case presentation:  Two male patients, aged 63 and 62, were enrolled. Both had HBV -related HCC and staged beyond Hangzhou Criteria. Case 1 had previous partial hepatectomy for HCC and developed multiple intrahepatic recurrences. Both had longer operation time than usual, hemorrhage and prolonged hypotension during LT, due to extensive adhesions and coagulopathy.Both received a triple immunosuppressive regimen.  Subsequently, both developed AP postoperatively at day 14 and day 7. Abdominal CT revealed an enlarged pancreas with peripancreatic encapsulated effusion around the head and tail of the pancreas, respectively(Fig. 1A, C). They were managed conservatively by somatostatin, enteral nutrition and peripancreatic effusion drainage (ultrasound or CT-guided). Case 2 required additional nephroscope-guided debridement for the pancreatic abscess. Case 1 had resolved peripancreatic effusion at day 62 post-LT(Fig.1B), Case 2 still had peripancreatic encapsulated effusion at day 35 post-LT(Fig.1D).
Conclusions: AP is a rare complication in post LT patients. Common causative factors include surgical factors, infection, biliary complications and immunosuppression. In this study, prolonged intraoperative hypotension and extensive dissection during the operation might be the cause of AP. Conservative management by somatostatin, drainage and minimally invasive surgical procedures for debridement was important in treating AP post-LT.