title: Renal allograft rejection with normal renal function in simultaneous kidney/pancreas recipients: does dissynchronous rejection really exist?
abstract: BACKGROUND
  Between July 1, 1994 and December 1, 1998, 147 simultaneous kidney/pancreas transplantations were performed at our center. Of 95 patients who experienced at least one acute renal allograft rejection episode after transplantation, 7 (7.4%) developed rejection in the presence of stable and normal or near-normal renal function.
  
  
  METHODS
  The indication for renal allograft biopsy was a rising serum lipase, i.e., suspected pancreatic rejection. All seven patients were treated with steroids and augmentation of the tacrolimus dose, with a fall in the serum lipase and no change in the serum creatinine.
  
  
  RESULTS
  The serum creatinine levels just before, at the time of, 1 week after the biopsy, and at most recent follow-up were 1.4+/-0.4, 1.3+/-0.3, 1.2+/-0.2, and 1.2+/-0.2 mg/dl. The serum lipase levels just before, at the time of, 1 week after the biopsy, and at most recent follow-up were 1022+/-1157 mg/dl, 874+/-996 mg/dl, 243+/-260 mg/dl, and 94+/-75 mg/dl. The tacrolimus dosages and levels at the time of the biopsy and 1 week later were 14.9+/-5.0 mg/day and 15.0+/-4.0 ng/ml, and 16.4+/-6.3 mg/day and 15.1+/-6.8 ng/ml.
  
  
  CONCLUSIONS
  These findings suggest that, in patients undergoing simultaneous kidney/pancreas transplantation, the entity of dissynchronous pancreatic allograft rejection without renal allograft rejection may not really exist. These data also make an additional fundamental point that acute rejection may occur in patients with normal and stable renal function.
authors.affiliation: Thomas E. Starzl Transplantation Institute, Division of Urologic Surgery, University of Pittsburgh, Pennsylvania 15213, USA.
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
authors.forename: M L
authors.initials: ML
authors.lastname: Jordan
authors.forename: V P
authors.initials: VP
authors.lastname: Scantlebury
authors.forename: C A
authors.initials: CA
authors.lastname: Vivas
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.forename: J
authors.initials: J
authors.lastname: McCauley
authors.forename: M F
authors.initials: MF
authors.lastname: Egidi
authors.forename: P
authors.initials: P
authors.lastname: Randhawa
authors.forename: P
authors.initials: P
authors.lastname: Chakrabarti
authors.forename: R J
authors.initials: RJ
authors.lastname: Corry
mesh_terms: D006084:Graft Rejection; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation; D016035:Pancreas Transplantation; D014184:Transplantation, Homologous