Early detection of rejection in pancreas transplantation.
A major dilemma in pancreas transplantation is the lack of reliable methods for the early detection of allograft rejection. Over a 26-mo period, 70 rejection episodes occurred in 36 patients (13 isolated-pancreas, 23 simultaneous pancreas-kidney recipients) with pancreaticoduodenocystostomy. A total of 300 radionuclide pancreas examinations were performed (mean 8.3/patient) utilizing 99mTc-labeled DTPA. Computer analysis generated a quantitative measure of blood flow to the allograft (technetium index, TI). Rejection episodes were defined as isolated pancreas, isolated kidney, or combined pancreas-kidney. Mean urinary amylase (UA) levels and TI during normal allograft function were 30,256 U/L and 0.57%, respectively, whereas levels heralding rejection were 6873 U/L and 0.39% (P less than .05). The treatment of rejection based on kidney dysfunction or combined pancreas-kidney dysfunction resulted in significantly higher graft salvage and a lower incidence of hyperglycemia compared with isolated-pancreas-allograft rejection. After therapy, a TI greater than 0.3% was associated with 95.9% graft survival, whereas levels less than 0.3% resulted in a 72.7% rate of graft loss (P less than .001). Similarly, pancreas allografts with a UA greater than 10,000 U/L had 92.2% functional survival, whereas levels less than 10,000 U/L resulted in a 53.3% rate of graft loss (P less than 0.001). Overall, reversal of rejection occurred in 80% of cases, with 10 pancreas and 2 kidney allografts lost due to rejection. 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.
Stratta
R J
RJ
Department of Surgery, University of Wisconsin School of Medicine, Madison.
Sollinger
H W
HW
Perlman
S B
SB
D'Alessandro
A M
AM
Groshek
M
M
Kalayoglu
M
M
Pirsch
J D
JD
Belzer
F O
FO
D000328:Adult; D000681:Amylases / Q000652:urine; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D009942:Organometallic Compounds; D010179:Pancreas / Q000000981:diagnostic imaging; D016035:Pancreas Transplantation; D004369:Pentetic Acid; D011877:Radionuclide Imaging; D016284:Technetium Tc 99m Pentetate
D009942:Organometallic Compounds; D004369:Pentetic Acid; D000681:Amylases; D016284:Technetium Tc 99m Pentetate