Pancreas graft rejection: Incidence, treatment and outcomes

UVA PD; QUEVEDO A; ROSES J; PILOTTI R; TONIOLO F; ALVARENGA E; CHULUYAN E

Buenos Aires

Congreso; XXIX International Congress of the Transplantation Society (TTS 2022); 2022

The Transplantation Society (TTS)

Introduction: Pancreas rejection continues to be a major cause of graft failure (GF). Treatment protocols differ among transplant centers.Materials and Methods: Since December 2011 pancreas biopsies are performed systematically at any graft dysfunction and pancreas rejection is treated according to rejection type and grade. The objective is to report incidence, type, grade, treatment and outcomes of pancreas rejection until March, 2022. Standard anti-rejection treatment: Indeterminate and Banff 1: Steroid pulses, Banff 2: SP+ Thymoblobulin. AMR: Steroid pulses, plasmapheresis and IVIG, Mixed rejection: SP+Thymo+PP+IVIG. However, due to kidney discordant grade or rejection and/or patient condition, treatment may have varied.Results: We have performed 419 pancreas transplants at our center, of which 242 were performed during the study period. The incidence of rejection was 17% at 1y and 25% at 5y. We analyzed 93 pancreas biopsy proven rejections. Among the 71 first episodes, there were 4 indeterminate rejections (0% GF), 43 Banff 1 rejections (7% GF), 15 Banff 2 rejections (33% GF) 8 AMR (25% GF) and 1 chronic rejection (100% GF)