Enzo Angeli MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: No imaging modality can demonstrate islet presence, survival and function after intraportal transplantation in diabetic patients. Few literature reports showed focal fatty changes (FFC) of liver parenchyma related to local insulin secretion. Recently, we recognized at sonography liver echotexture abnormalities due to FFC and related to islet survival. The purpose of our study is to determine prevalence and meaning of these abnormalities. Methods and Materials: From 1991 to 2002, 30 diabetic patients submitted to 35 percutaneous intraportal transplantation of purified pancreatic islets, had a regular sonographic follow up. Sonograms of liver parenchyma with color Doppler evaluation of portal vasculature were performed before islet transplant, immediately after the infusion, at one month and every 6 months. Sonograms were prospectively and blindly evaluated for possible hyperechoic FFC and portal vein abnormalities. Percutaneous large core needle biopsies were performed in the last period when liver echotexture modifications were observed. Results were correlated with serum liver enzyme (AST, ALT, GGT), fasting C- peptide (f C-P), glycaeted haemoglobin (HbA1c) and Exogeneous Insulin Requirement (EIR). Results: No alterations of liver enzymes were observed. No portal vein abnormalities were reported, excepting for one segmental thrombosis, spontaneously restored at six months control. FFC consisting in micro (< 5 mm) or macro focal hyperchogenicity were found after 12/35 (34.3 %) procedures, mostly with diffuse microfocal distribution, in three cases also with segmental distribution. FFC were always detectable 6 months after the implants and lasted from 6 months to 7 years. Considering only the 30 cases of functionally successful implants (f C-P >1ng/ml) at six months follow up, FFC were evident in 40 % of them. FFC presence always positively correlated with islet viability and function. The histological examinations of liver biopsies performed in 8/12 cases positive at sonography showed mild to moderate, mainly macrovesicular steatosis, focally and randomly distributed, and focal nuclear glycogen accumulation; portal fibrosis and inflammation were absent or not significant. Conclusion: FFC are relatively frequent after intraportal islet transplantation; clinical and histopathologic data show that FFC detectable at sonography must be considered the expression of a prolonged over-stimulus of insulin secretion, determining the storage of fat and glycogen in the liver cell, as already shown in the animal model.      

Angeli MD, E, Sonographic and Histological Liver Changes after Intraportal Islet Transplantation in Type 1 Diabetes.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3105979.html