Hepatic steatosis after islet transplantation: Can ultrasound predict the clinical outcome? A longitudinal study in 108 patients

Single-centre experience of extending indications for percutaneous intraportal islet autotransplantation (PIPIAT) after pancreatic surgery to prevent diabetes: feasibility, radiological aspects, complications and clinical outcome

“…The appearance of liver steatosis during follow-up has been considered as an early predictor of graft dysfunction. 18,19 Eligibility for PIPIAT was based on the following criteria: .18 years of age, written informed consent and fasting glycaemia of ,126 mg dl 21 without glucose-lowering medications. Pancreatic malignant disease was not considered as an absolute exclusion criterion, while exclusion criteria considered were the following conditions: (1) multifocal pancreatic neoplasm at pre-operative imaging or intraoperative evaluation, including multifocal benign intraductal papillary mucinous neoplasm; (2) suspected or confirmed diagnosis of multiple endocrine neoplasms; (3) transection margin involvement in the pancreatic pathology, including any degree of dysplasia or ductal disepithelization; and (4) any medical condition potentially compromising the safety of the PIPIAT procedure.…”

“…The detection of steatosis at ultrasound has been interpreted as a consequence of an islet-overworking activity owing to residual-stressed vital islets in insulin overproduction supporting other nonfunctioning islets: we have hypothesized that steatosis becomes ultrasonically detectable only when a significant peak of local insulin secretion is achieved. 19 An islet-overworking activity was previously demonstrated in some patients in whom transplantation failed. 41 In conclusion, the present study confirms that PIPIAT could be extended to different categories of patients, in centres experienced in islet transplantation and characterized by highvolume pancreatic surgery.…”

Single-donor islet transplantation in type 1 diabetes: patient selection and special considerations

“…First found in animal models, it has only been recently shown that this occurs in humans after transplantation 35. Various groups have started assessing for steatosis in their postoperative cohorts using a variety of imaging modalities, most notably ultrasound and MRI 36,37. In these studies, rates of fatty liver post-transplant have ranged from 17% to 24%.…”

“…Interestingly, some patients with fat deposition tend to have better graft function, as defined by superior beta scores compared to their non-steatotic counterparts. Graft function tends to diverge late (40+ months), those with steatosis experiencing faster rates of graft exhaustion and increased islet loss 36. This finding is not universal, however, as at least one group has found contradictory data 38…”

Allo- and auto-percutaneous intra-portal pancreatic islet transplantation (PIPIT) for diabetes cure and prevention: the role of imaging and interventional radiology

“…In our recent longitudinal study on 108 patients based on US (50) and involving all the 3 islet-transplanted populations (IAK, ITA and auto-transplanted patients), steatosis at US after PIPIT ( Figure 14) was interpreted as an early sign of graft dysfunction (51). Our hypothesis is that steatosis appearance at US is related to the overworking activity of some residual vital stressed islets, resulting in insulin overproduction supporting other non-functioning islets: in our opinion, steatosis becomes ultrasonically detectable only when an abnormal peak of local insulin secretion is achieved (50,51). After steatosis detection at US, progressive graft exhaustion was observed until steatosis disappearance in all the patients.…”