Prospective characterization of incident hepatic steatosis in pediatric and adolescent patients after total pancreatectomy with islet autotransplantation

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2022-12, Vol.22 (8), p.1175-1180
• Main Authors: Vieira Alves, Vinicius P., Qiu, Lisa, Abu-El-Haija, Maisam, Tellez, Siobhan, Vitale, David S., Lin, Tom K., Tkach, Jean A., Nathan, Jamie D., Dillman, Jonathan R., Trout, Andrew T.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Adult; Adults; Child; Children; Ethnicity; Fatty liver; Fatty Liver - diagnostic imaging; Fatty Liver - epidemiology; Fatty Liver - etiology; Female; Humans; Insulin; Islets of Langerhans Transplantation - adverse effects; Laboratories; Liver diseases; Magnetic Resonance Imaging; Medical records; Pancreatectomy; Pancreatectomy - adverse effects; Pancreatitis; Pediatrics; Prospective Studies; Proton density fat fraction; Software; Steatosis; Teenagers; Total pancreatectomy with islet autotransplantation; TPIAT; Transplantation, Autologous; Ultrasonic imaging
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2022.09.242

Hepatic steatosis has been described as a common finding in adults following total pancreatectomy with islet autotransplantation (TPIAT) but it is unknown if this occurs in children and adolescents. To define the frequency of post-TPIAT hepatic steatosis in a sample of children and adolescents and to identify clinical predictors of incident steatosis post-TPIAT. In this prospective study, consecutive participants at least 1-month post-TPIAT underwent a liver MRI with proton density fat fraction (PDFF) and blood draw at our pediatric academic medical center between April 2021 and January 2022. Comparison clinical pre-TPIAT liver MRI or ultrasound and insulin use and graft function data were extracted from the medical record. T-tests were used for the comparison of means across continuous variables between participants with and without post-TPIAT steatosis. A total of 20 participants (mean: 13 ± 4 years; 12 female) were evaluated. Mean liver PDFF at research MRI was 7.4 ± 6.2% (range: 2–25%). Seven participants (35%) had categorical hepatic steatosis (PDFF>5%) post-TPIAT, five of whom had pre-TPIAT steatosis, reflecting a 13% (2/15; 95% CI: 2–40%) incidence of post-TPIAT steatosis. Participant characteristics were not significantly different between subgroups with and without post-TPIAT steatosis. Mean PDFF at research MRI was not different between graft function subgroups (7.5% optimal/good vs. 7.3% marginal/failure; p = .96). Our study shows a moderate prevalence but low incidence of hepatic steatosis in a small sample of children and adolescents post-TPIAT. This study raises questions about a causal relationship between TPIAT and hepatic steatosis.