Diagnosis of early pancreas graft failure via antibody-mediated rejection: single-center experience with 256 pancreas transplantations.
Early pancreas graft loss is usually attributed to technical failure while the possibility of antibody-mediated rejection (AMR) is generally overlooked. To investigate the role of AMR in early pancreas graft loss, we retrospectively assessed 256 patients with simultaneous pancreas-kidney transplantation (SPK) between 1985 and 2010 at our institute. We included 33 SPK patients who lost their pancreas graft <1 year after transplantation. AMR was diagnosed based on donor-specific antibodies, C4d and histology in 7 cases, 8 cases were suspicious for AMR and 18 pancreas graft losses were not due to AMR. Acute AMR occurred >1 month after transplantation in 6/7 cases, whereas all other causes typically led to loss <1 month after transplantation. Thrombotic lesions occurred equally among the 33 cases. In 12/18 concurrent kidney specimens, the diagnostic results paralleled those of the pancreas graft. All patients with acute AMR of the pancreas graft lost their renal grafts <1 year after transplantation. In the setting of a thrombotic event, histopathological analysis of early pancreas graft loss is advisable to rule out the possibility of AMR, particularly because a diagnosis of acute AMR has important consequences for renal graft outcomes.
Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands.
H
H
de Kort
M J K
MJ
Mallat
C
C
van Kooten
E
E
de Heer
S H
SH
Brand-Schaaf
A M
AM
van der Wal
C
C
Roufosse
D L
DL
Roelen
J A
JA
Bruijn
F H
FH
Claas
J W
JW
de Fijter
I M
IM
Bajema
D000328:Adult; D064591:Allografts; D016022:Case-Control Studies; D015935:Complement C4b / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000150:complications* / Q000601:surgery; D010446:Peptide Fragments / Q000276:immunology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000503:physiopathology*; D014019:Tissue Donors
D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d
Antibodies; antibody-mediated rejection; complement C4d; graft rejection; histopathology; pancreas transplantation