Abstract
For characterization of histopathological changes during pancreas graft rejection, pancreaticoduodenal transplants were performed in three groups: (1) Brown Norway into diabetic Lewis rats without immunosuppression, (2) Brown Norway into diabetic Lewis rats with cyclosporin A, and (3) Lewis into Lewis rats. Diffuse inflammatory infiltration of the acini by mononuclear cells indicated the onset of rejection (stage I). Shortly after acinar infiltration, damage to small and large interlobular excretion ducts occurred. This took the form of florid circumferential inflammation and vacuolar degeneration of epithelium similar to the bile duct damage seen in primary biliary cirrhosis, graft-versus-host disease, and liver allograft rejection (stage II). Thereafter, endothelialitis and destruction of islets were evident, consistent with a more advanced and irreversible stage of rejection (stage III). Acinar inflammation and moderate duct lesions were not prevented by immunosuppression but were delayed. Nonetheless, severe vascular changes and loss of islets were avoided. We conclude that duct lesions are a reliable criterion for pancreas allograft rejection. They are more sensitive than vascular changes and more specific than cellular infiltration of acinar tissue, which may also occur in infection.
Similar content being viewed by others
References
Allen RDM, Wilson TG, Grierson JM, Greenberg ML, Earl MJ, Stewart JH, Little JM, Chapman JR (1990) Percutaneous pancreas transplant fine needle aspiration and needle core biopsies are useful and safe. Transplant Proc 22:663–664
Brattström C, Tyden G, Malmborg AS, Lundgren G, Öst L, Groth CG (1987) Studies of the exocrine secretion of segmental pancreatic grafts with special reference to the diagnosis of rejection and to the penetration of drugs into the pancreatic juice. Transplant Proc 19:2332–2335
Carpenter HA, Engen DE, Munn SR, Barr D, Marsh CL, Ludwig J, Perkins JD (1990) Histologic diagnosis of rejection by using cystoscopically directed needle biopsy specimens from dysfunctional pancreatoduodenal allografts with exocrine drainage into the bladder. Am J Surg Pathol 14:837–846
Fenell RH Jr, Shikes RH, Vierling JM (1983) Relationship of pretransplant hepatobiliary disease to that of bile duct damage occurring in the liver allograft. Hepatology 3:84–89
Gaudecker B von, Ulrichs K, Müller-Ruchholtz W (1989) Immunoelectron microscopic localization of MHC structures in isolated pancreatic rat islets. Diabetes 38 [Suppl 1]:150–153
Klima G, Margreiter R (1989) Pancreatic juice cytology in the monitoring of pancreas allografts. Transplantation 48:980–985
Königsrainer A, Habringer C, Krausler R, Margreiter R (1990) A technique of pancreas transplantation in the rat securing pancreatic juice for monitoring. Transplant Int 3:181–182
Königsrainer A, Dietze O, Habringer C, Krausler R, Klima G, Margreiter R (1991) Morphology of acute rejection and corresponding cytological findings in exocrine secretion after pancreas transplantation in the rat. Transplantation (in press)
Melzer JS, D'Allessandro AM, Kalayoglu M, Pirsch JD, Belzer FO, Sollinger HW (1990) The use of OKT3 in combined pancreas-kidney allotransplantation. Transplant Proc 22:634–635
Portmann B, Neuberger JM, Williams R (1983) Intrahepatic bile duct lesions. In: Calne RY (ed) Liver transplantation. Grune and Stratton, London, pp 279–287
Portmann B, Popper H, Neuberger J, Williams R (1985) Sequential and diagnostic features in primary biliary cirrhosis, based on serial histologic study in 209 patients. Gastroenterology 88:1777–1790
Prieto M, Sutherland DER, Fernandez-Cruz L, Heil J, Najarian JS (1987) Experimental and clinical experience with urine amylase monitoring for early diagnosis of rejection in pancreas transplantation. Transplantation 43:73–79
Shulman HM, McDonald GB (1984) Liver disease after marrow transplantation. In: Sale GE, Shulman HM (eds) The pathology of bone marrow transplantation. Masson, New York, pp 104–135
Sibley RK, Sutherland DER (1987) Pancreas transplantation. Am J Pathol 128:151–170
Snover DC, Freese DK, Sharp HL, Bloomer JR, Najarian JS, Ascher NL (1987) Liver allograft rejection. An analysis of the use of biopsy in determining outcome of rejection. Am J Surg Pathol 11:1–10
Steiner E, Klima G, Niederwieser G, Königsrainer A, Herold M, Margreiter R (1987) Monitoring of the pancreatic allograft by analysis of exocrine secretion. Transplant Proc 19:2336–2338
Steiniger B, Klempnauer J (1986) Distinct histologic patterns of acute, prolonged and chronic rejection in vascularized rat pancreas allografts. Am J Pathol 124:253–262
Steiniger B, Klempnauer J, Wonigeit K (1985) Altered distribution of class I and class II MHC antigens during acute pancreas allograft rejection in the rat. Transplantation 40:234–239
Steiniger B, Hiller WFA, Klempnauer J (1990) Identical pattern of acute rejection after isolated islet and vascularized whole-pancreas transplantation in the rat. Am J Pathol 137:93–102
Sutherland DER, Casanova D, Sibley RK (1987) Role of pancreas graft biopsies in the diagnosis and treatment of rejection after pancreas transplantation. Transplant Proc 19:2329–2331
Sutherland DER, Dunn DL, Goetz FC, Kennedy W, Ramsay RC, Steffes MW, Mauer SM, Gruessner R, Moudry-Munns KC, Morel P, Viste A (1989) A 10-year experience with 290 pancreas transplantations at a single institution. Ann Surg 210: 274–288
Timmermann W, Schang T, Thiede A (1985) Modelle und Perspektiven der Pankreastransplantation bei der Ratte. II. Der Abstoßungsverlauf von pankreaticoduodenalen Transplantaten verschiedener Histokompatibilität und unter dem Einfluß temporärer Therapie mit Ciclosporin (Sandimmun). Langenbecks Arch Chir 363:235–243
Author information
Authors and Affiliations
About this article
Cite this article
Dietze, O., Königsrainer, A., Habringer, C. et al. Histological features of acute pancreatic allograft rejection after pancreaticoduodenal transplantation in the rat. Transplant Int 4, 221–226 (1991). https://doi.org/10.1007/BF00649107
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00649107