08-2: ASSOCIATION OF LIVER BIOPSY FINDINGS BEFORE TOTAL PANCREATECTOMY AND ISLET AUTO-TRANSPLANTATION (TPIAT) WITH ISLET GRAFT FUNCTIONAL OUTCOMES

Abstract

Introduction: Background. In total pancreatectomy with islet autotransplantation (TPIAT), islets are typically infused into the liver, but little is known regarding the impact of pre-operative liver health on islet transplant complications and function. The aim of this study is to evaluate the association of liver histopathology on pre-TPIAT biopsy with islet graft function at one-year follow-up and on post-operative portal vein thrombosis. Methods: Methods. Data from 168 patients who underwent liver biopsy before TPIAT were retrospectively reviewed. Biopsy findings --including steatosis, inflammation, fibrosis, and presence of steatohepatitis or a severe liver pathology-- were evaluated against the graft function at one year follow-up and the development of post-operative portal vein thrombosis (within 1 week post-TPIAT). Results: Results. Among 168 patients undergoing TPIAT (11-63 years old), 75 (45%), 42 (25%), and 16 (9.5%), had steatosis, inflammation, or fibrosis on liver biopsy before TPIAT, respectively. Among these, 11 patients fulfilled the criteria for steatohepatitis, and liver pathology findings were classified as moderate-to-severe in 22 patients. None of the liver biopsy abnormalities were associated with portal vein thrombosis. Meal-stimulated C-peptide (1-hour post BoostHP) was lower in those with steatohepatitis at 1 year post-TPIAT (p=0.045, R2=.031), and remained associated in multiple regression model adjusted for age, sex, BMI, transplanted IEQ/Kg (p=.039). A moderate-to-severe liver pathology was associated with low C-peptide category (<0.6 ng/dL 1 hour stimulated) at 1 year post-TPIAT (OR=.280, p=.039). This remained significant after adjusting for confounders including age, sex, preoperative BMI, and transplanted IEQ/Kg (OR=.175, p=.028). Insulin independence was not significantly associated with biopsy findings after adjusting for key covariates. Conclusions: Conclusion. Our data suggests that presence of steatohepatitis or a moderate-to-severe liver pathology at the time of TPIAT is associated with reduced islet autograft function after TPIAT, even after accounting for islet mass transplanted. Further validation of these associations in larger cohorts is required.