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Early diagnosis and treatment of pancreas allograft rejection

  • Original Articles
  • Published:
Transplant International

Abstract

A major problem in vascularized pancreas transplantation is the lack of reliable methods for the early diagnosis and effective treatment of allograft rejection. Over a 2-year period, 54 rejection episodes occurred in 31 patients (13 isolated pancreas, 18 simultaneous pancreas-kidney recipients) with pancreaticoduodenocystostomy. A total of 253 radionuclide pancreas examinations were performed (mean 8.4 per patient) utilizing 99mtechnetium-DTPA. Computer analysis generated a quantitative measure of blood flow to the allograft caused the technetium index (TI). Rejection episodes were characterized as isolated pancreas (22), combined pancreas-kidney (16), or isolated renal (16) allograft rejection in combined engraftments. The majority of rejection episodes occurred early (within 3 months of transplant, N=47) and were more responsive than late rejection to anti-rejection therapy (89.4% vs 42.9%, P=0.01). Mean urinary amylase (UA) levels and TI during normal allograft function were 29,398 U/l and 0.55%, while levels heralding rejection were 6,528 U/l and 0.40%, respectively (P<0.05). The treatment of rejection based upon renal dysfunction or combined renal and pancreas dysfunction resulted in significantly higher graft salvage with a lower incidence of hyperglycemia when compared to isolated pancreas allograft rejection. Of the 11 patients who developed hyperglycemia, 8 (72.7%) ultimately lost their pancreas grafts (P<0.001). Following therapy, a TI above 0.3% was associated with 97.4% graft survival, while levels below 0.3% resulted in a 70% rate of graft loss (P<0.001). Similarly, pancreas allografts with a UA above 10,000 U/l had 91.1% functional survival, while levels below 10,000 U/l resulted in a 66.7% rate of graft loss (P<0.001). Overall, reversal of rejection occurred in 83.3% of cases, with 9 grafts lost due to rejection at a mean of 4.7 months post-transplant. Therapy with ALG or OKT3 was more effective in reversing allograft rejection than pulsed corticosteroids alone (68.8% vs 47.9%, P=0.05). Patient and pancreas allograft survival is 96.8% and 67.7%, respectively, after a mean follow-up interval of 14.9 months. Monitoring pancreas allograft function by UA, TI, and renal function (in simultaneous transplants) allows for the timely diagnosis and successful treatment of pancreas allograft rejection.

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin Hospital, 600 Highland Avenue, 53792, Madison, WI, USA

    Robert J. Stratta, Hans W. Sollinger, Scott B. Perlman, Anthony M. D'Alessandro, Marilyn Groshek, Munci Kalayoglu, John D. Pirsch & Folkert O. Belzer

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  1. Robert J. Stratta
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  2. Hans W. Sollinger
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  3. Scott B. Perlman
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  4. Anthony M. D'Alessandro
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  5. Marilyn Groshek
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  6. Munci Kalayoglu
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  7. John D. Pirsch
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  8. Folkert O. Belzer
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Stratta, R.J., Sollinger, H.W., Perlman, S.B. et al. Early diagnosis and treatment of pancreas allograft rejection. Transplant Int 1, 6–12 (1988). https://doi.org/10.1007/BF00337842

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