title: Vessel rejection secondary to human leucocyte antigen antibodies directed against the arterial conduit following pancreas transplantation from a separate donor.
abstract: Whole-organ pancreas transplantation is typically carried out using a Y-graft derived from the donor iliac vessels. We describe a case in which a 31-year-old male underwent a simultaneous pancreas-kidney transplant, but in which vessels from a different donor were used for the arterial anastomosis of the pancreas graft. Although initially there was good function, 18 months post-transplant the patient was admitted with diabetic ketoacidosis secondary to pancreas graft failure. Radiological investigations revealed complete occlusion of the vascular Y-graft, and laboratory investigations demonstrated donor-specific human leucocyte antigen (HLA) antibodies directed against HLA mismatches of the vessel donor. This case highlights the risks of using allogeneic vascular material for surgical anastomoses.
authors.affiliation: Oxford Transplant Centre, Oxford University Hospitals NHS Trust, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
authors.forename: Shruti
authors.initials: S
authors.lastname: Mittal
authors.forename: Suzanne
authors.initials: S
authors.lastname: Page
authors.forename: Mian
authors.initials: M
authors.lastname: Chen
authors.forename: Jeanette
authors.initials: J
authors.lastname: Procter
authors.forename: James
authors.initials: J
authors.lastname: Gilbert
authors.forename: Edward
authors.initials: E
authors.lastname: Sharples
authors.forename: Peter
authors.initials: P
authors.lastname: Friend
authors.forename: Susan
authors.initials: S
authors.lastname: Fuggle
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D000906:Antibodies / Q000276:immunology; D006084:Graft Rejection / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation; D014019:Tissue Donors
chemical_list: D000906:Antibodies
keywords: donor-specific antibodies; pancreas transplant