Fecal pancreatic elastase-1 in the evaluation of pancreatic function after pediatric intestinal transplantation
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Published on: May 5, 2018
Stuart S Kaufman1, Xiaogang Simon Zhong2, Ahmed M Elsabbagh3
1MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC, USA.
Insights
Fat malabsorption after small bowel transplant (SBT) is common. Liver-intestine-pancreas transplants promote faster pancreatic function recovery, though most patients eventually normalize fecal pancreatic elastase (FPE).
Area of Science:
- Gastroenterology
- Transplant Surgery
- Pediatric Surgery
Background:
- Fat malabsorption is a frequent complication following small bowel transplantation (SBT).
- Exocrine pancreatic insufficiency can contribute to post-SBT fat malabsorption.
- Understanding the impact of graft type on pancreatic function is crucial for patient outcomes.
Purpose of the Study:
- To investigate if different anatomical variants of small bowel transplantation (SBT) influence the occurrence of exocrine pancreatic insufficiency.
- To assess the recovery of pancreatic function, measured by fecal pancreatic elastase (FPE), in SBT recipients.
- To correlate transplant type with the normalization of FPE levels and identify factors affecting recovery.
Main Methods:
- Fecal pancreatic elastase (FPE) was measured repeatedly in 54 small bowel transplant (SBT) recipients.
- Patients were categorized by graft type: isolated intestinal, en bloc liver-intestinal-pancreas, or multivisceral.
- FPE levels were analyzed in relation to time post-transplant and graft type.
Main Results:
- Initially, 15 out of 54 patients had normal FPE (>200 μg/g) within a median of 22 days post-SBT.
- Recipients of en bloc liver-intestinal-pancreas grafts were more likely to achieve normal FPE early (within 30 days) compared to other groups (47% vs. 19% and 0%).
- Most patients (34/39) eventually normalized FPE at a median of 168 days, irrespective of transplant type. Five patients (9%) failed to achieve normal FPE, with three deaths within two years.
Conclusions:
- Transplantation of an en bloc liver-intestinal-pancreas graft facilitates earlier normalization of fecal pancreatic elastase (FPE).
- While early recovery is faster with combined grafts, most patients eventually achieve normal FPE regardless of transplant type.
- Failure to recover normal pancreatic function post-SBT may indicate severe complications and is associated with increased mortality.
Abstract:
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.
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