Pancreas rejection with hyperglycemia. Is it always too late?

UVA, PABLO D.; QUEVEDO ALEJANDRA; ROSES JOSEFINA; PILOTTI ROXANA; TONIOLO FERNANDA; CHULUYAN, EDUARDO; CASADEI, DOMINGO

Seul

Congreso; 28th International Congress of The Transplantation Society; 2020

The Transplantation Society

Introduction: Hyperglycemia is usually considered a late sign in pancreasrejection, often times correlating with high grades of rejection and low ratesof graft recovery. At our center, pancreas dysfunction is an indication forsimultaneous kidney and pancreas biopsies. The purpose of this study is toreport the prevalence, grades and types of pancreas rejection in this setting,and the response to anti-rejection treatment.Methods: From Janurary, 2013 to December, 2019 we have performed41 pancreas biopsies in patients with hyperglycemia. 26 had acute rejection(63%). Non-acute rejection cases were reported as normal findings(4), PTDM (4), CNI toxicity (3), severe chronic damage (3), and 1 suspectedrecurrence of autoimmunity. Acute rejection cases were 11 TCMR grade 1, 9TCMR grade 2, 3 AMR and 3 mixed rejections. After anti-rejection treatment,10 patients were discharged with no insulin requirements. Among them, 4had recurrent rejection at a mean time of 24 months and 2 patients loss theirgrafts. On the other hand, 16 patients were on insulin after anti-rejectiontreatment. Among them 6 patients never recovered pancreas function andlost their grafts. In contrast, 4 patients recovered pancreas function althoughcontinue to require small amounts of insulin (less than 50% of pre transplantrequirements). Finally, there were 6 cases in which patients became off-insulinat a mean time of 2.4 months after treatment (0.3-3.8 months). Amongthese patients 2 developed recurrent rejection and lost their grafts at a meantime of 13 months of follow-up.Conclusions: Hyperglycemia after pancreas transplantation is associatedwith pancreas graft rejection in about 2/3 of the cases, and can be present ina variety of grades and types of rejection. With anti-rejection treatment morethan 58% of the patients can recover pancreas graft function. It may takeseveral weeks for some patients to became off of insulin.