title: Reported isolated pancreas rejection is associated with poor kidney outcomes in recipients of a simultaneous pancreas kidney transplant.
abstract: BACKGROUND
  We hypothesized that many reported and presumed isolated pancreas acute rejection episodes in simultaneous pancreas kidney patients may in fact be missed concordant kidney acute rejection episodes.
  
  
  METHODS
  To test this hypothesis, we undertook an analysis of the Organ Procurement and Transplant Network database from 1995 to 2006 to assess the impact of reported isolated pancreas rejection on kidney allograft outcomes. The primary outcome of interest was kidney graft status beyond the first posttransplant year.
  
  
  RESULTS
  For overall graft survival, we found that when pancreas alone rejection was compared with no rejection there was a significant difference between the curves (log-rank P<0.0001). In addition, this endpoint was also significant for death censored graft survival (log-rank P=0.0036). For both overall and death censored graft survival the multivariate analyses demonstrated an increased risk (adjusted hazards ratio: 2.46, 3.22, respectively) for patients reported to have pancreas alone rejection.
  
  
  CONCLUSIONS
  These results indicate that patients with isolated pancreas rejection have worse renal allograft survival than patients reported as having no acute rejection and fare at least as poorly as those with reported kidney graft rejection supporting the concept of concordance of acute rejection in the majority of patients.
authors.affiliation: Department of Surgery, University of Illinois, Transplant Center, Chicago, IL 60612, USA. kaplanb@uic.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Kaplan
authors.forename: Patricia
authors.initials: P
authors.lastname: West-Thielke
authors.forename: Heather
authors.initials: H
authors.lastname: Herren
authors.forename: John
authors.initials: J
authors.lastname: Gill
authors.forename: Greg A
authors.initials: GA
authors.lastname: Knoll
authors.forename: Jose
authors.initials: J
authors.lastname: Oberholzer
authors.forename: Howard
authors.initials: H
authors.lastname: Sankary
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D014184:Transplantation, Homologous