title: Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation.
abstract: The effect of acute allograft rejection (AR) on long-term pancreas allograft function is unclear. We retrospectively studied 227 consecutive pancreas transplants performed at our institution between January 1, 998 and December 31, 2009 including: 56 simultaneous pancreas and kidney (SPK), 69 pancreas transplantation alone (PTA); and 102 pancreas after kidney (PAK) transplants. With a median follow-up of 6.1 (IQR 3-9) years, 57 patients developed 79 episodes of AR, and 19 experienced more than one episode. The cumulative incidence for AR was 14.7%, 19.7%, 26.6% and 29.1% at 1, 2, 5 and 10 years. PTA transplant (hazards ratio [HR]=2.28, p=0.001) and donor age (per 10 years) (HR=1.34, p=0.006) were associated with higher risk for AR. The first AR episode after 3 months post PT was associated with increased risk for complete loss (CL) (HR 3.79, p<0.001), and the first AR episode occurring during 3- to 12-month and 12- to 24-month periods after PT were associated with significantly increased risk for at least partial loss (PL) (HR 2.84, p=0.014; and HR 6.25, p<0.001, respectively). We conclude that AR is associated with increased risk for CL and at least PL. The time that the first AR is observed may influence subsequent graft failure.
authors: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, MN.|Department of Endocrinology and Metabolism, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China.
authors: M
authors: M
authors: Dong
authors: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: A K
authors: AK
authors: Parsaik
authors: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors: W
authors: W
authors: Kremers
authors: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, MN.|Department of Endocrinology and Metabolism, Zibo First People's Hospital, Zibo, Shandong, P. R. China.
authors: A
authors: A
authors: Sun
authors: Division of Transplantation Surgery, Department of Surgery.
authors: P
authors: P
authors: Dean
authors: Division of Transplantation Surgery, Department of Surgery.
authors: M
authors: M
authors: Prieto
authors: Division of Nephrology and Hypertension, Department of Internal Medicine.
authors: F G
authors: FG
authors: Cosio
authors: Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology.
authors: M J
authors: MJ
authors: Gandhi
authors: Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors: L
authors: L
authors: Zhang
authors: Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors: T C
authors: TC
authors: Smyrk
authors: Division of Transplantation Surgery, Department of Surgery.
authors: M D
authors: MD
authors: Stegall
authors: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Y C
authors: YC
authors: Kudva
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D010182:Pancreatic Diseases / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents