Department of Surgery, University Transplant Program, Rush University Medical Center, Chicago, IL, USA.
Prog Transplant. 2023 Sep;33(3):236-241. doi: 10.1177/15269248231189877. Epub 2023 Jul 30.
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.
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.
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.
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.
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.
胰腺移植后体重增加是一种尚未被充分理解的现象，据认为与移植后胰岛素生成增加、免疫抑制药物和食欲变化有关。没有研究调查过移植后外分泌增加的影响。
我们假设粪便弹性蛋白酶-1（FE-1）的外分泌功能在移植后是正常的，与体重增加无关。我们的主要目的是研究胰腺移植后 FE-1 水平的变化，并将其与体重增加相关联。确定体重趋势和识别其他相关因素是次要目的。
本研究纳入了 2013 年至 2021 年期间在一家中心接受同时胰腺和肾脏或肾脏后胰腺移植的 42 例患者。前瞻性地在每个患者的单个时间点测量粪便弹性蛋白酶，将 >500μg/g 归类为高。获取体重和 C 肽值。所有患者均接受无类固醇免疫抑制治疗。
19 例（45%）患者的粪便弹性蛋白酶水平>500μg/g，最高达 3910μg/g；43%的患者水平超过正常上限的两倍。体重增加最大发生在第 1 年至第 2 年之间，中位数体重增加持续至 3 年时为 14%。体重增加与 FE-1、移植前 C 肽水平或糖尿病持续时间均无相关性。
本研究表明胰腺移植后存在外分泌弹性蛋白酶水平升高和体重增加，但两者之间无相关性。需要进行前瞻性研究，在移植前后进行多次 FE-1 检测，以更好地评估其与体重增加的相关性。
