Development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: proposal of a postoperative NAFLD scoring system.
BACKGROUND
The main etiology of NAFLD and NASH after pancreatic resection is still unclear, and the therapeutic strategy has yet to be established. The focus of this review is how predict and prevent NAFLD/NASH after pancreaticoduodenectomy.


METHODS
From April 2005 to October 2008, 54 patients who underwent pancreaticoduodenectomy in our institution were enrolled in this study. From the pre-, intra- and postoperative risk factors, we identified the most influential risk factors of postoperative NAFLD by uni- and multivariate analyses. Moreover, a postoperative NAFLD scoring system was proposed based on these risk factors.


RESULTS
The incidence of postoperative NAFLD was 37.0% (20/54). Of these, 10% (2/20) of patients were diagnosed as having NASH by percutaneous liver biopsy. By multivariate analysis, pancreatic adenocarcinoma (p < 0.05), pancreatic resection line (p < 0.01) and postoperative diarrhea (p < 0.01) were identified as the most influential factors concerning postoperative NAFLD. Based on these results, we proposed a postoperative NAFLD scoring system (0-10) and evaluated the correlation between the score and decreasing rates of CT values, revealing a significant correlation (r = 0.829 p < 0.001). The prevalence of postoperative NAFLD in the patients with our scores of 0-3, 4-6 and 7-10 points was 0 (0/22), 35 (6/17) and 93% (14/15), respectively.


CONCLUSIONS
In conclusion, NAFLD develops frequently in patients who undergo PD, and some patients even progress to NASH. A postoperative NAFLD scoring system makes it possible to predict the occurrence of NAFLD after PD, and aggressive nutrition support is needed for patients with high scores.
Kato
Hiroyuki
H
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan. kato0719@clin.medic.mie-u.ac.jp
Isaji
Shuji
S
Azumi
Yoshinori
Y
Kishiwada
Masashi
M
Hamada
Takashi
T
Mizuno
Shugo
S
Usui
Masanobu
M
Sakurai
Hiroyuki
H
Tabata
Masami
M
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D003967:Diarrhea / Q000453:epidemiology; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010194:Pancreatin / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
D005765:Gastrointestinal Agents; D010194:Pancreatin