Liver biopsy may facilitate pancreatic graft evaluation: Positive association between liver steatosis and pancreatic graft adipose infiltration

Abstract

OBJECTIVES:The number of pancreatic transplants has decreased in recent years. Pancreatic grafts have been underutilized compared to other solid grafts. One cause of discard is the macroscopic appearance of the pancreas, especially the presence of fatty infiltration. The current research is aimed at understanding any graft-related association between fatty tissue infiltration of the pancreas and liver steatosis.METHODS:From August 2013 to August 2014, a prospective cross-sectional clinical study using data from 54 multiple deceased donor organs was performed.RESULTS:Micro- and macroscopic liver steatosis were significantly correlated with the donor body mass index ([BMI]; p=0.029 and p=0.006, respectively). Positive gamma associations between pancreatic and liver macroscopic and microscopic findings (0.98; confidence interval [CI]: 0.95–1 and 0.52; CI 0.04–1, respectively) were observed. Furthermore, comparisons of liver microscopy findings showed significant differences between severe versus absent (p<0.001), severe versus mild (p<0.001), and severe versus moderate classifications (p<0.001). The area under the receiver operating curve was 0.94 for the diagnosis of steatosis by BMI evaluation using a cut-off BMI of 27.5 kg/m2, which yielded 100% sensitivity, 87% specificity, and 100% negative predictive value.CONCLUSIONS:We observed a positive association of macroscopic and microscopic histopathological findings in steatotic livers with adipose infiltration of pancreatic grafts.

Pancreatic Steatosis: A New Diagnosis and Therapeutic Challenge in Gastroenterology

“…Pancreatic steatosis is common in patients with NAFLD, and pancreatic fat content positively correlates with liver steatosis grading determined by histology (46,47) . Patients with histologydetermined liver fibrosis have significantly less pancreatic fat infiltration than those without evidence of liver fibrosis (48) .…”

Nonalcoholic Fatty Pancreas Disease

“…Whereas liver graft steatosis is easily analyzed from both the macroscopic and microscopic points of view, and liver biopsy is very accurate, macroscopic pancreatic examinations can be difficult, and pancreatic biopsy can be hazardous. According to Nacif et al, a liver biopsy may facilitate pancreatic graft evaluation for fat, as evidenced by a positive association of macroscopic and microscopic histopathological findings in fatty livers with fatty infiltration of pancreatic grafts …”

Hypertension, but not body mass index, is predictive of increased pancreatic lipid content and islet dysfunction

“…To this end, several studies have attempted to characterize pancreatic steatosis in humans using histopathology 10,11 and in vivo imaging techniques, including magnetic resonance imaging (MRI), [12][13][14][15][16][17][18][19][20] magnetic resonance spectroscopy (MRS), [21][22][23][24] ultrasonography, [25][26][27][28][29][30][31][32][33] computed tomography (CT), [34][35][36] and combinations of these techniques. 37,38 Although MRI and MRS remain the most sensitive imaging options for estimating donor pancreas fat content in vivo, these techniques are time-consuming and impractical to incorporate into the donor workflow.…”