Introduction Weight gain after pancreas transplant is a poorly understood phenomenon thought to be related to increased posttransplant insulin production, immunosuppressive medications, and appetite changes. No study has investigated the effect of increased exocrine secretion posttransplant. Aims and Hypothesis We hypothesized that exocrine function, measured by fecal elastase-1 (FE-1), was normal posttransplant and not correlated with weight gain. Our primary aim was to investigate changes in FE-1 levels with pancreas transplantation and to correlate this with weight gain. Establishing weight trends and identifying additional correlating factors were secondary aims. Design Forty-two patients that underwent simultaneous pancreas and kidney or pancreas after kidney transplant at a single center between 2013 and 2021 were included. Fecal elastase was measured prospectively in each patient at a single time point, with >500 µg/g categorized as high. Weight and C-peptide values were obtained. All the patients were on steroid-free immunosuppression. Results Nineteen patients (45%) had fecal elastase levels >500 µg/g, with a maximum of 3910 µg/g; 43% had levels greater than twice the upper limit of normal. The biggest increase in weight occurred between years 1 and 2, which continued to a median weight gain of 14% at 3 years. There was no correlation between weight gain and FE-1, pretransplant C-peptide levels, or duration of diabetes. Conclusion This study demonstrated supranormal fecal elastase levels and weight gain posttransplant; however, there was no correlation. Future study with serial FE-1 before and after transplant is needed to better assess its correlation with weight gain.
Introduction: Weight gain after pancreas transplant is a growing concern. Weight gain can lead to post-transplant comorbidities such as diabetes type 2. A few small studies have investigated weight gain after pancreas transplantation, but none have considered the role of the exocrine pancreas. At the time of pancreas transplant, some patients maintain normal exocrine function from their native pancreas. Therefore, we hypothesized that the presence of two exocrine pancreases (native and graft) may contribute to post-transplant weight gain via supranormal levels of pancreatic exocrine secretions within the GI tract, which may contribute to increased nutrient absorption. Methods: We performed a single-center descriptive study including patients that received pancreas transplant between June 2013 through January 2021. The operative technique was the same in all patients, with systemic vascular drainage from graft portal vein to recipient inferior vena cava, and enteric drainage of the pancreas via an anastomosis between graft duodenum and recipient proximal jejunum. Stool samples were collected from all patients at a single time-point in the post-transplant period. Stool was used to measure fecal elastase-1 (FE-1) in order to quantify the exocrine function of native and/or graft pancreas. Levels of FE-1 were correlated with levels of post-transplant weight gain. Results: 42 patients were included in the study (Figure 1). The median FE-1 was 432 ug/g. For those with excessive weight gain (defined by >7% body weight), median was 409 ug/g. For those without excessive weight gain, FE-1 was 405 ug/g. There was no correlation between FE-1 and weight gain post-transplant. There was an inverse correlation between FE-1 and time from transplant (p=0.02), which can be seen in Figure 2. Post-transplant weight trends were similar to prior studies, where patients lost up to 8% of body weight at 1-month post-transplant and returned to baseline weight by 6 months. The largest increase in weight occurred post-transplant between years one and two. Conclusion: Exocrine secretions appear to decrease over time following pancreas transplant. Additional prospective research, with evaluation of preand post-transplant FE-1 will be required to determine the influence of exocrine function on weight gain following pancreas transplantation.
Background: Sarcopenia is defined as the loss of muscle mass and function and has been associated with worsened outcomes, including disability and mortality. The aim of this study was to describe the prevalence of sarcopenia in patients who had an abdominal computed tomography (CT) scan completed within 7 days of hospital admission. Methods: A retrospective study was conducted. Adult patients admitted to either the general medical or surgical floor were included. Muscle function was assessed using handgrip strength (HGS, kg), completed within the first 48 hours of admission. Skeletal muscle index (SMI, kg/m 2 ) at the third lumber region was calculated among patients who had an abdominal CT scan completed within 7 days of admission. Sarcopenia was identified by the combination of low SMI and HGS. The primary outcome was the percentage of patients diagnosed with sarcopenia. Results: A total of 1318 patients were admitted; 11% (n = 141) had an abdominal CT scan completed within 7 days of admission. Only race and prevalence of malnutrition were different between patients who did and did not have a CT completed. The overall prevalence of sarcopenia was 13% (n = 18/141). Additionally, 39% of the sample was at risk for sarcopenia, with either low SMI (n = 13/141) or low HGS (n = 42/141).Conclusions: Overall prevalence of sarcopenia was low, but more than one-third of patients had either low SMI or low HGS. Minimal differences were observed between patients who did and did not have an abdominal CT scan completed upon admission.
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