Graft dysfunction in simultaneous pancreas kidney transplantation (spk): results of concurrent kidney and pancreas allograft biopsies

UVA, P D; PAPADIMITRIOU, J C; DRACHENBERG, C B; TONIOLO, F; QUEVEDO, A; DOTTA, A C; CHULUYAN, E; CASADEI, D H

AMERICAN JOURNAL OF TRANSPLANTATION

WILEY-BLACKWELL PUBLISHING, INC

Lugar: Londres; Año: 2018

1600-6135

Simultaneous pancreas and kidney transplants offer significant therapeutic advantages but present a diagnostic approach dilemma in the diagnosis of rejection. Since both organs are from the same donor the kidney has been traditionally treated as the "sentinel" organ to biopsy, presumably representing the status of both allografts. Truly concurrent biopsy studies, however are needed to confirm this hypothesis. We examined 101 concurrent biopsies from 70 patients with dysfunction in either or both organs. Results showed concurrent rejection in 23/57 (40%) of cases with rejection. 19/57 (33.5%) and 15/57 (26.5%) showed kidney or pancreas only rejection, respectively. The degree and type of rejection differed in the majority (13/23, 56.5%) of cases with concurrent rejection, with the pancreas more often showing higher rejection grade. Taking into account pancreas dysfunction a positive kidney biopsy should correctly predict pancreas rejection in 86% of the instances. However, the lack of complete concordance between the two organs, the discrepancies in grade and type of rejection, and the tendency for higher rejection grades in concurrent or pancreas only rejections, all support the rationale for pancreas biopsies. The latter provide additional data on the overall status of the organ, as well as information on non-rejection related pathologies. This article is protected by copyright. All rights reserved.