Giulia Agostini, Presenter: Nothing to Disclose

Massimo Venturini MD, Abstract Co-Author: Nothing to Disclose

Giulia Querques, Abstract Co-Author: Nothing to Disclose

Paola Maffi, Abstract Co-Author: Nothing to Disclose

Antonio Secchi, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

PIPIT is a less invasive, repeatable therapeutic option in brittle type 1 diabetes, compared to surgical pancreas transplantation: it can be performed after kidney-transplantation (IAK), alone (ITA) in type-1 diabetic pts without chronic renal insufficiency, or as an autotransplantation (IAT) after pancreatectomy (immunosuppression unnecessary). Steatosis is a consequence of the islets’ engraftment: its meaning is controversial. Our retrospective longitudinal study aimed to assess hepatic steatosis incidence at ultrasound (US) after islet auto- and allotransplantation, and to identify any relationship with graft function.

From 1989 to 2012, 108 pts (33 IAK, 50 ITA, 25 IAT) underwent PIPIT, which is performed under a combined US and fluoroscopic guidance. US was performed at baseline/6/12/24 months. Steatosis first detection/prevalence/duration/distribution were recorded. Steatosic (S) and non-steatosic patients (NS) were compared for the following parameters at baseline/6/12/24 months: insulin-independence-rate, ß-score, C-peptide, glycated-hemoglobin, exogenous-insulin-requirement, fasting-plasma-glucose, infused-islet-mass. C-peptide is the traditional marker of islet function, but ß-score is a more comprehensive parameter, including all the previously mentioned ones.

Steatosis was found in 21/108 pts, 24% (20/83) allotransplanted, 4% (1/25) autotransplanted (better outcome), with first detection at 6 months, highest prevalence at 1 year (18 cases). Infused-islet-mass was significantly higher in S than NS patients (IE/kg: S=10.822; NS=6.138). Metabolically, S pts had worse basal conditions (ß score: S=1.7 ± 1.6; NS=2.8 ± 2.8), but better islet function at the time of steatosis first detection (ß score: S=3.9 ± 2.0; NS=2.9 ± 2.3), after which a progressive islet exhaustion, along with steatosis disappearance, was observed. Conversely, in NS pts these parameters remained more stable in time.

Steatosis at US seems to be related to islet mass and overworking activity. Presence of steatosis precedes metabolic alterations, can predict graft dysfunction addressing therapeutic decisions before islet exhaustion. Absence of steatosis doesn’t allow any conclusion.  

Steatosis at US precedes metabolic alterations and can predict graft’s dysfunction addressing to therapeutic decisions before islet exhaustion. If steatosis doesn’t appear, no conclusion can be drawn.

Agostini, G, Venturini, M, Querques, G, Maffi, P, Secchi, A, Del Maschio, A, Hepatic Steatosis after Percutaneous Intraportal Pancreatic Islet Transplantation (PIPIT) in 108 Allo-and Auto-Transplanted Patients: Can Ultrasound Predict the Clinical Outcome?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045803.html