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@ARTICLE{Launspach:298933,
      author       = {M. Launspach$^*$ and A. Mindermann and J. Schulz and L.
                      Alasfar and S. Cyrull and F. Zirngibl and L. Oevermann and
                      A. Künkele$^*$ and H. E. Deubzer$^*$ and H. von Bernuth and
                      A. Pruß and P. Lang and P. Bufler and A. Eggert$^*$ and A.
                      von Stackelberg and J. Schulte$^*$},
      title        = {{H}igh {I}ncidence and {I}mpact of {S}uspected {E}xocrine
                      {P}ancreatic {I}nsufficiency in {P}atients
                      {P}ost-{H}ematopoietic {S}tem {C}ell {T}ransplantation: {A}
                      {S}ingle-{C}enter {P}rospective {O}bservational {S}tudy.},
      journal      = {United european gastroenterology journal},
      volume       = {13},
      number       = {2},
      issn         = {2050-6406},
      address      = {Hoboken, NJ},
      publisher    = {Wiley},
      reportid     = {DKFZ-2025-00367},
      pages        = {257-267},
      year         = {2025},
      note         = {2025 Mar;13(2):257-267},
      abstract     = {Exocrine pancreatic insufficiency (EPI) is suspected but
                      remains understudied in immunosuppressed conditions such as
                      post-hematopoietic stem cell transplantation (HSCT). This
                      prospective observational study aimed to investigate the
                      incidence, impact, and risk factors of EPI in a cohort of 83
                      pediatric and young adult patients who underwent allogeneic
                      HSCT at Charité - Universitätsmedizin Berlin between 2020
                      and 2023. Fecal pancreatic elastase (PE) measurements and
                      transabdominal ultrasound were utilized to evaluate
                      pancreatic function over a one-year period. Secondary
                      analysis explored the association of EPI with clinical
                      complications and included a multivariable regression
                      analysis of potential risk factors. Low PE levels
                      significantly correlated with pathological pancreatic
                      imaging findings, independent of concurrent diarrhea. EPI
                      was suspected in $45\%$ (32/71) of patients $(95\%CI:$
                      $[34.1\%,$ $56.6\%]),$ with $29\%$ (13/45) $(95\%CI:$
                      $[17.7\%,$ $43.4\%])$ showing signs of prolonged EPI (pEPI)
                      lasting at least 8 weeks. After excluding cases with
                      confounding factors such as missing enteral nutrition and
                      diarrhea, the cumulative incidence of prolonged EPI was
                      $20\%$ (8/41) $(95\%CI:$ $10.2\%-34.0\%)$ in the overall
                      cohort. EPI was associated with weight loss, prolonged
                      dependence on parenteral nutrition, and extended
                      hospitalizations. Adenovirus (ADV) infection emerged as a
                      significant risk factor for EPI (hazard ratio 3.22
                      $[95\%CI:1.26-8.2],$ p = 0.014), along with additional
                      factors such as higher BMI pre-HSCT, pre-existing pancreatic
                      damage and early post-HSCT fasting. The persistence of
                      pancreatic atrophy and EPI beyond two years post-HSCT in
                      individual cases suggests a potential for permanent
                      pancreatic damage. This study underscores that EPI is a
                      common complication following HSCT, with ADV infection being
                      an important risk factor. The findings support routine PE
                      measurements and early initiation of pancreatic enzyme
                      replacement therapy (PERT), alongside aggressive treatment
                      of ADV infections. Further research is necessary to evaluate
                      the effects of PERT in this population and to explore the
                      applicability of these findings in other immunosuppressed
                      groups.},
      keywords     = {adenovirus infection (Other) / bone marrow transplantation
                      (Other) / exocrine pancreas function (Other) / fecal
                      elastase (Other) / immunosuppression (Other) / pancreas
                      elastase (Other) / pancreas imaging (Other) / pancreas
                      ultrasound (Other) / pancreatitis (Other) / stem cell
                      transplantation (Other)},
      cin          = {BE01},
      ddc          = {610},
      cid          = {I:(DE-He78)BE01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39955611},
      doi          = {10.1002/ueg2.12769},
      url          = {https://inrepo02.dkfz.de/record/298933},
}