Department of Radiology, San Raffaele Scientific Institute, Milan, Italy.
Diabet Med. 2010 Aug;27(8):960-4. doi: 10.1111/j.1464-5491.2010.03035.x.
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.
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.
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.
Liver focal fatty changes at ultrasound (steatosis) after islet transplantation in IAK and ITA patients may represent an early sign of altered graft function.
可供胰岛移植单独（ITA）和胰岛肾后（IAK）移植患者使用的肝移植胰岛后纵向影像学研究很少。特别有争议的是胰岛功能与胰岛诱导的肝局灶性脂肪变化之间的联系。本研究的目的是评估胰岛移植后超声检查肝局灶性脂肪变化及其与胰岛功能的关系。
评估 30 例 IAK 移植患者、5 例 ITA 患者中肝局灶性脂肪变化的首次超声检测时间以及这些变化的发生率和持续时间，并根据移植后 1 年的胰岛功能评估将其分为全功能、部分功能和无功能组。对持续超声检测到肝局灶性脂肪变化的患者进行肝活检。比较超声阳性和阴性且胰岛功能正常的患者在随访期间的胰岛功能和 C 肽水平。还记录了 1 年后胆固醇/甘油三酯和其他代谢参数的变化。
在 12 例患者（10/30 IAK，2/5 ITA）中发现超声肝局灶性脂肪变化。8 例患者首次检测时间为 6 个月，4 例患者为 12 个月。8 例患者的肝超声变化持续时间超过 1 年。8/8 例患者肝组织学检查发现脂肪变性。12 个月时，部分胰岛功能患者（10/12，8 例 IAK，2 例 ITA）肝超声变化程度大于全胰岛功能患者。与超声阴性患者相比，超声阳性患者的 C 肽水平显著降低。18 个月时，与超声阴性患者（3/18）相比，超声阳性患者功能恶化的可能性更大（9/12）。无论是在总患者数还是 IAK 和 ITA 患者中，胆固醇/甘油三酯水平均无统计学差异。
IAK 和 ITA 患者胰岛移植后超声（脂肪变性）肝局灶性脂肪变化可能是移植物功能改变的早期迹象。
