Transaminitis after pancreatic islet transplantation.
BACKGROUND
An asymptomatic, self-limited transaminitis uniformly follows pancreatic islet transplantation (PIT) performed through portal vein (PV) infusion. The underlying cause and significance of this transaminitis is unclear.


METHODS
Records of all patients with insulin-dependent diabetes mellitus who had undergone PIT at our institution were reviewed. All PITs were performed in conjunction with a remote pancreatic islet isolation center and done through percutaneous transhepatic PV infusion. Alanine aminotransferase (ALT) levels, serum glucose concentrations, insulin requirements, and color-flow Doppler ultrasonography examinations of the right upper quadrant were assessed before and after PIT.


RESULTS
Eleven patients have undergone a total of 26 PITs. An elevated ALT level occurred in all 11 patients (100%) after the first PIT, with the median post-PIT peak ALT level reaching 187 IU/L. Transaminitis was less frequent and less marked after the second PIT. A negative correlation between viability of the pancreatic islets transplanted (r = -0.44, p = 0.03) and a positive correlation between the ratio of maximum to initial PV pressure (r = 0.41, p = 0.04) were seen with the subsequent ALT peak. Color-flow Doppler ultrasonography examinations showed no occurrences of PV thrombosis or intrahepatic hematoma. Finally, the degree of transaminitis did not correlate with post-PIT insulin requirements, indicating that post-PIT transaminitis cannot be used to measure allograft rejection or function.


CONCLUSIONS
Transaminitis after PIT is common and self-limited. Post-PIT transaminitis does not signal acute rejection or serious procedure-related complications such as PV thrombosis or intrahepatic hematoma.
Barshes
Neal R
NR
Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Lee
Timothy C
TC
Goodpastor
Sarah E
SE
Balkrishnan
Rajesh
R
Schock
A Paige
AP
Mote
Amy
A
Brunicardi
F Charles
FC
Alejandro
Rodolfo
R
Ricordi
Camillo
C
Goss
John A
JA
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000201:enzymology / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000201:enzymology / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000201:enzymology / Q000209:etiology; D006801:Humans; D007515:Islets of Langerhans / Q000378:metabolism*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000209:etiology; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color
D015415:Biomarkers; D001786:Blood Glucose; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase