Endoscopic Management of Obstructive Chronic Pancreatitis in a Dual Solid Organ Transplant Recipient: A Case Report

A 47-year-old woman with alcohol-related cirrhosis underwent simultaneous donor orthotopic liver transplantation and kidney transplantation. Her post-transplant course was complicated by a biliary anastomotic stricture, endoscopic retrograde cholangiopancreatography (ERCP)-related biliary perforation, and bile leak requiring percutaneous transhepatic cholangioplasty. Five years post-transplant, she developed progressive obstructive chronic pancreatitis with main pancreatic duct dilation to 10 mm, intraductal calculi, exocrine pancreatic insufficiency, and type 3c (pancreatogenic) diabetes with peak glycated hemoglobin of 9.6%. She underwent five serial ERCP procedures with pancreatic sphincterotomy, balloon dilation, stone extraction, and progressive plastic stent placement (5 Fr to 7 Fr), achieving modest weight gain, reduced pain, improved oral intake, and better glycemic control. Surgical decompression was deferred due to prohibitive operative risk. At nine months, the pancreatic stent was electively removed, and the patient remains under active multidisciplinary surveillance. This case demonstrates that serial endoscopic pancreatic duct decompression is feasible for managing obstructive chronic pancreatitis in dual solid organ transplant recipients when surgery carries excessive risk.