Liver focal fatty changes at ultrasound after islet transplantation: an early sign of altered graft function?

• Published in: Diabetic medicine Vol. 27; no. 8; pp. 960 - 964
• Main Authors: Venturini, M., Angeli, E., Maffi, P., Losio, C., Pozzi, P., Paties, C., Cellina, M., De Cobelli, F., Fiorina, P., Secchi, A., Del Maschio, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2010; Blackwell
• Subjects: Adult; Biological and medical sciences; Blood Glucose - metabolism; Diabetes Mellitus, Type 1 - diagnostic imaging; Diabetes Mellitus, Type 1 - pathology; Diabetes Mellitus, Type 1 - therapy; Endocrinopathies; Fatty Liver - diagnostic imaging; Fatty Liver - pathology; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; insulin action; islet; Islets of Langerhans Transplantation; Male; Medical sciences; Middle Aged; Ultrasonography; ultrasound; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Sonography; Obesity; Pancreatic hormone; Nutrition; Digestive system; Liver; Nutrition disorder; Langerhans islet; Homograft; Metabolic diseases; Change; islet; Insulin; insulin action; Graft; Early; Ultrasound; Endocrinology; Nutritional status; Endocrine pancreas
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2010.03035.x

Diabet. Med. 27, 960–964 (2010) Aims  Few longitudinal imaging studies of liver‐engrafted islets after islet transplantation are available for islet‐transplant‐alone (ITA) and islet‐after‐kidney (IAK) transplanted patients. Particularly controversial is the link between islet function and the appearance of islet‐induced liver focal fatty changes. Aims of this study were to assess liver focal fatty changes at ultrasound after islet transplantation and their relationship with islet function. Methods  The timing of first ultrasound detection of liver focal fatty changes and the prevalence and duration of these changes were assessed in 30 IAK transplanted patients, in five ITA patients and, retrospectively, in full‐, partial‐ and no‐function groups, according to islet function evaluated 1 year after transplantation. Patients with persistent ultrasound detected liver focal fatty changes underwent liver biopsy. Ultrasound positive and negative patients with functioning islets were compared for islet‐function and C‐peptide‐levels during the follow‐up. Variations of cholesterol/triglycerides and other metabolic parameters were also recorded at 1 year. Results  Liver focal fatty changes at ultrasound were found in 12 patients (10/30 IAK, 2/5 ITA). First detection was at 6 months in eight cases and at 12 months in four cases. Liver ultrasound changes were of more than 1 year duration in eight cases. Steatosis was found histologically in 8/8 patients. At 12 months, liver ultrasound changes were detected to a greater extent in patients with partial islet function (10/12, eight IAK, two ITA) compared with patients with full islet function. C‐peptide‐levels were significantly lower in ultrasound‐positive than in ultrasound‐negative patients. At 18 months, ultrasound‐ positive patients were more prone to worsening of their function (9/12) compared with ultrasound‐negative patients (3/18). No statistically significant differences of cholesterol/triglycerides levels were found in either the total number of patients or the IAK and ITA patients. Conclusions  Liver focal fatty changes at ultrasound (steatosis) after islet transplantation in IAK and ITA patients may represent an early sign of altered graft function.