Influence of liver histopathology on transaminitis following total pancreatectomy and autologous islet transplantation.
BACKGROUND
In type 1 diabetics undergoing allogenic islet transplants, transaminitis and portal vein thrombosis (PVT) after transhepatic portal infusion of islets may be related to infusion pressure and the purity of islets. Complications of intraoperative portal infusion of islets in patients with chronic pancreatitis undergoing a total pancreatectomy (TP) and autologous islet transplant (AIT) and the relationship to liver histopathology have not been examined.


OBJECTIVE
The purpose of this study was to examine complications of intraportal infusion of autologous islets after TP.


METHODS
Data on 26 TP-AIT patients were analyzed.


RESULTS
Infusion of islets [mean 304,473 ± 314,557 islet equivalents, median volume 300 mL (50-600)] resulted in mean postinfusion PV pressure of 9.15 ± 10.09 cmH2O which correlated with infused islets equivalents (r (2) = 33.6, P = 0.002) and volume (r (2) = 30.4, P = 0.005). Of 23 patients undergoing liver biopsy, 8 (35 %) were normal, 10 (43 %) had steatosis, and 5 (22 %) periportal fibrosis. Peak alanine aminotransferase (ALT; median 1 day after infusion) differed among the three histologic groups (P = 0.025). The difference in ALT was statistically significant between steatosis (showed the greatest increase) and the other two groups, but not between the normal and fibrosis groups. No correlation was found between the portal pressure increase at infusion and other variables. Two patients that developed PVT on day 1 had the highest infusion pressures; a third occurred on day 5.


CONCLUSIONS
Preexisting liver pathology is a contributing factor in the rise in liver enzymes but does not correlate with development of PV thrombosis.
Section of Transplantation, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 85724, USA. csdesai@gmail.com
Chirag S
CS
Desai
Khalid M
KM
Khan
Felipe B
FB
Megawa
Horacio
H
Rilo
Tun
T
Jie
Angelika
A
Gruessner
Rainer
R
Gruessner
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D008099:Liver / Q000201:enzymology / Q000473:pathology; D008107:Liver Diseases / Q000201:enzymology / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D012189:Retrospective Studies; D014182:Transplantation, Autologous / Q000009:adverse effects; D055815:Young Adult
D000410:Alanine Transaminase