title: Antibody-mediated rejection (AMR) after pancreas and pancreas-kidney transplantation.
abstract: Antibody-mediated rejection (AMR) requires specific diagnostic tools and treatment and is associated with lower graft survival. We prospectively screened C4d in pancreas (n = 35, in 27 patients) and kidney (n = 33, in 21 patients) for cause biopsies. Serum amylase and lipase, amylasuria, fasting blood glucose (FBG) and 2-h capillary glucose (CG) were also analysed. We found that 27.3% of kidney biopsies and 43% of pancreatic biopsies showed C4d staining (66.7% and 53.3% diffuse in peritubular and interacinar capillaries respectively). Isolated exocrine dysfunction was the main indication for pancreas biopsy (54.3%) and was followed by both exocrine and endocrine dysfunctions (37.1%) and isolated endocrine dysfunction (8.6%). Laboratorial parameters were comparable between T-cell mediated rejection and AMR: amylase 151.5 vs. 149 U/l (P = 0.075), lipase 1120 vs. 1288.5 U/l (P = 0.83), amylasuria variation 46.5 vs. 61% (P = 0.97), FBG 69 vs. 97 mg/dl (P = 0.20) and 2-h CG maximum 149.5 vs. 197.5 mg/dl (P = 0.49) respectively. Amylasuria values after treatment correlated with pancreas allograft loss (P = 0.015). These data suggest that C4d staining should be routinely investigated when pancreas allograft dysfunction is present because of its high detection rate in cases of rejection.
authors.affiliation: Pancreas-Kidney Transplantation Unit, Hospital Israelita Albert Einstein - HIAE, São Paulo, Brazil. erikabr@uol.com.br
authors.forename: Erika B
authors.initials: EB
authors.lastname: Rangel
authors.forename: Denise M A C
authors.initials: DM
authors.lastname: Malheiros
authors.forename: Maria Cristina Ribeiro
authors.initials: MC
authors.lastname: de Castro
authors.forename: Irina
authors.initials: I
authors.lastname: Antunes
authors.forename: Margareth A
authors.initials: MA
authors.lastname: Torres
authors.forename: Fábio
authors.initials: F
authors.lastname: Crescentini
authors.forename: Tércio
authors.initials: T
authors.lastname: Genzini
authors.forename: Marcelo
authors.initials: M
authors.lastname: Perosa
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D010179:Pancreas / Q000473:pathology; D016035:Pancreas Transplantation / Q000276:immunology*
chemical_list: D007518:Isoantibodies