Incidence and Longitudinal Trajectory of de novo Hepatic Steatosis after Pancreatoduodenectomy: A Prospective Cohort Study Using Transient Elastography.

BACKGROUND/AIMS: De novo hepatic steatosis is a recognized complication following pancreaticoduodenectomy (PD); however, its incidence and longitudinal course remain poorly defined. We prospectively evaluated the incidence, temporal trajectory, and risk factors for de novo hepatic steatosis after PD using vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP).

METHODS

Consecutive patients scheduled for PD at Asan Medical Center between October 2020 and October 2023 were prospectively enrolled. Patients with baseline CAP ≥250 dB/m, preexisting diabetes mellitus, viral hepatitis, or significant alcohol consumption were excluded. De novo hepatic steatosis was defined as CAP ≥275 dB/m on follow-up VCTE. Assessments were performed at 6, 12, 18, and 24 months after surgery. The primary outcome was cumulative incidence at 12 months.

RESULTS

Of 116 enrolled patients, 100 were eligible and 92 underwent at least one postoperative CAP measurement. The cumulative incidence of de novo hepatic steatosis at 12 months was 28.7% (95% confidence interval [CI], 18.6% to 37.6%). Point prevalence peaked at 3 months (20.3%) and declined to 13.1% at 24 months. Among patients with steatosis at 12 months, 55.6% showed resolution by 24 months. Preoperative body mass index was an independent predictor of steatosis development (adjusted hazard ratio, 1.41 per 1 kg/m2; 95% CI, 1.13 to 1.76; p=0.003).

CONCLUSIONS

De novo hepatic steatosis developed in approximately one-quarter of patients after PD and showed a partially reversible course. Higher preoperative body mass index and adjuvant chemotherapy independently predicted its development, supporting systematic postoperative hepatic surveillance using VCTE.