Kaufman Stuart S, Zhong Xiaogang Simon, Elsabbagh Ahmed M, Bailey Dominique, Yazigi Nada A, Khan Khalid M, Matsumoto Cal S
MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC, USA.
Department of Biostatistics and Bioinformatics, Georgetown University, Washington, DC, USA.
Pediatr Transplant. 2018 Jun 21:e13247. doi: 10.1111/petr.13247.
Fat malabsorption is common after SBT. To identify whether anatomic variant transplants differ in occurrence of exocrine pancreatic insufficiency that could contribute to fat malabsorption, we measured FPE repeatedly in 54 recipients of a SBT, ages 6.2 to 320 months. FPE determination most distant from SBT was 6.1 years. Of the 54, 39% received an isolated intestinal graft (native pancreas only), 48% received an en bloc liver-intestinal-pancreas graft (native and graft pancreas), and 13% received a multivisceral graft (graft pancreas only). Initial FPE was normal (>200 μg/g) in 15 of the 54 at a median of 22 (11-61) days after SBT. Recipients of a liver-intestine-pancreas transplant were more likely to have normal FPE within 30 days after SBT than were isolated intestinal or multivisceral transplant recipients (47%, 19%, and 0%, respectively, P = .049). Of the remaining 39 patients, 34 eventually demonstrated a normal FPE at a median of 168 (31-943) days after SBT. Type of SBT did not influence the likelihood of achieving a normal FPE level or time when it occurred. Five (9%) patients failed to achieve normal FPE, including 3 who died within 2 years after SBT. In conclusion, possessing both graft and native pancreas as in transplantation of an en bloc liver-intestinal-pancreas graft facilitates early normalization of FPE that eventually occurs in most patients irrespective of transplant type. Failure to recover normal pancreatic function may be associated with severe post-transplant complications.
小肠移植术后脂肪吸收不良很常见。为了确定解剖学变异移植在可能导致脂肪吸收不良的外分泌性胰腺功能不全发生率方面是否存在差异，我们对54名年龄在6.2至320个月的小肠移植受者反复测量了粪便弹性蛋白酶（FPE）。距小肠移植最远的FPE测定时间为6.1年。在这54名受者中，39%接受了孤立性肠移植（仅保留自身胰腺），48%接受了整块肝脏 - 肠 - 胰腺移植（自身胰腺和移植胰腺），13%接受了多脏器移植（仅移植胰腺）。54名受者中有15名在小肠移植后中位数为22（11 - 61）天的初始FPE正常（>200μg/g）。肝脏 - 肠 - 胰腺移植受者在小肠移植后30天内FPE正常的可能性高于孤立性肠移植或多脏器移植受者（分别为47%、19%和0%，P = 0.049）。在其余39名患者中，34名最终在小肠移植后中位数为168（31 - 943）天显示FPE正常。小肠移植类型不影响达到正常FPE水平的可能性或其出现的时间。5名（9%）患者未能达到正常FPE，其中3名在小肠移植后2年内死亡。总之，整块肝脏 - 肠 - 胰腺移植中同时拥有移植胰腺和自身胰腺有助于FPE早期恢复正常，最终大多数患者无论移植类型如何都会出现这种情况。未能恢复正常胰腺功能可能与严重的移植后并发症相关。
