Incidence of and risk factors (RFs) for development of non-alcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) for pancreatic cancer: A single institutional review.

Abstract

398 Background: PD may increase the risk of development of NAFLD, a precursor for non-alcoholic steatohepatitis and cirrhosis. Studies have not clearly identified consistent RFs for NAFLD, but patients with post-PD NAFLD do not appear to have the traditional RFs for NAFLD such as metabolic syndrome. The primary objective of this study was to identify the incidence of and RFs for post-PD NAFLD. Methods: Retrospective chart review was done on 425 patients who underwent PD for a cancer diagnosis at our institution from 2007 to 2017 and had at least 6 months of postoperative follow up. Cox proportional hazards model was used to examine multiple potential pre-operative RFs for NAFLD including body mass index (BMI), estimated surgical blood loss, LFTs, hemoglobin, albumin, age, sex, comorbidities, and tobacco use as predictors of time to develop post-PD NAFLD. Patients without post-PD NAFLD were considered censored at the time of last follow-up. The proportional hazard assumptions were validated. Post-PD NAFLD was identified by review of radiology reports. Results: Sixty (14.1%) of the 425 patients had post-PD NAFLD. The male to female ratio was 236:189 and median follow up time was 1 year. Median age was 65 years with median time to NAFLD development of 7 months. Multivariate Cox Proportional Hazard model identified higher BMI and female sex as RFs for the development of post-PD NAFLD. Each 1-point increase in BMI implied an 8.43% increase in the hazard of fatty liver (HR = 1.083, 95% CI: 1.032-1.136; p=0.001). Females had 89.7% higher hazard of fatty liver compared to males (HR = 1.897, 95% CI: 1.084 - 3.319; p=0.025). There was no statistically significant association between post-PD NAFLD and other pre-operative characteristics studied. Conclusions: Female sex and higher BMI may be RFs for the development of NAFLD post-PD. No other pre-operative RFs were identified. In conclusion, patients with higher BMI and female gender may need closer monitoring for earlier detection and management of NAFLD. [Table: see text]