Monitoring with plasma apolipoprotein A2-isoforms can predict developing new-onset steatotic liver disease caused by pancreatic exocrine insufficiency following pancreatectomy.

BACKGROUND: Development of new-onset steatotic liver disease (SLD) has been increasingly observed after pancreatectomy. However, the pathophysiology of post-operative SLD remains poorly understood. This study aimed to clarify the risk factors for new-onset SLD after pancreatectomy and verify the utility of monitoring plasma apolipoprotein A2-isoforms (apoA2-i) as a potentially promising biomarker for evaluating pancreatic exocrine function. METHODS: In this retrospective study of 79 patients who underwent pancreatectomy [47 pancreaticoduodenectomies (PDs) and 32 distal pancreatectomies (DPs)] between March 2021 and March 2024, the plasma apoA2-i (AT/AT and ATQ/ATQ) levels were measured using enzyme-linked immunosorbent assay (ELISA) methods, and non-contrast-enhanced computed tomography (CT) images were manually reviewed for the diagnosis of SLD. RESULTS: Comparing the minimum value of apoA2-AT/AT after surgery between the SLD (n=32) and non-SLD group (n=47), the apoA2-AT/AT value in the SLD group was significantly lower than that in the non-SLD group (P<0.001). The plasma apoA2-AT/AT levels <9.58 µg/mL (median of this cohort) was significantly associated with SLD (P<0.001) and an independent risk factor of SLD with both univariable [odds ratio (OR), 20.1; 95% confidence interval (CI): 6.59-74.5; P<0.001] and multivariable (OR, 13.6; 95% CI: 2.68-134.2; P=0.001) logistic regression analysis. Moreover, even when stratified by pre-onset pancrelipase administration, the cumulative incidence of SLD was significantly higher in patients with plasma apoA2-AT/AT levels <9.58 µg/mL (P<0.001). The point estimate of the area under the curve for detecting SLD of apoA2-AT/AT was 0.843. CONCLUSIONS: SLD associated with malnutrition following pancreatectomy can be predicted using plasma apoA2-i monitoring.