title: Antibody-mediated rejection of a pancreas allograft.
abstract: The role of antibody-mediated rejection (AMR) in pancreas transplantation is poorly understood. Here, we report on a patient who developed AMR of his pancreas allograft after receiving a simultaneous pancreas-kidney transplant. Pre-operative enhanced cytotoxicity and flow cytometry T-cell crossmatches were negative; B-cell crossmatches were not performed as per institutional protocol. The patient's post-operative course was significant for elevated serum amylase levels and development of hyperglycemia approximately 1 month after transplantation. A pancreatic biopsy at this time showed no cellular infiltrate but strong immunofluorescent staining for C4d in the interacinar capillaries. Analysis of the patient's serum identified donor-specific HLA-DR alloantibodies. He received intravenous immunoglobulin (IVIg), rituximab and plasmapheresis, and his pancreatic function normalized. We conclude that clinically significant AMR can develop in a pancreas allograft and recommend that pancreatic biopsies be assessed for C4d deposition if the patient has risk factors for AMR and/or the pathologic evidence for cell-mediated rejection is underwhelming.
authors.affiliation: Department of Surgery, University of California-San Francisco, San Francisco, California, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Melcher
authors.forename: J L
authors.initials: JL
authors.lastname: Olson
authors.forename: L A
authors.initials: LA
authors.lastname: Baxter-Lowe
authors.forename: P G
authors.initials: PG
authors.lastname: Stock
authors.forename: A M
authors.initials: AM
authors.lastname: Posselt
mesh_terms: D000328:Adult; D002196:Capillaries / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D008297:Male; D010956:Plasmapheresis; D012079:Renal Circulation; D014184:Transplantation, Homologous / Q000276:immunology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D007518:Isoantibodies