Graft dysfunction in simultaneous pancreas kidney transplantation (SPK): Results of concurrent kidney and pancreas allograft biopsies

Simultaneous pancreas and kidney transplants offer significant therapeutic advantages but present a diagnostic approach dilemma in the diagnosis of rejection. Because both organs are from the same donor, the kidney has been treated traditionally as the “sentinel” organ to biopsy, presumably represen...

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Bibliographic Details
Published in:American journal of transplantation 2019-02, Vol.19 (2), p.466-474
Main Authors: Uva, Pablo D., Papadimitriou, John C., Drachenberg, Cinthia B., Toniolo, María F., Quevedo, Alejandra, Dotta, Ana C., Chuluyan, Eduardo, Casadei, Domingo H.
Format: Article
Language:English
Subjects:
Adult
Allografts
Biopsy
clinical research / practice
Female
Follow-Up Studies
Graft rejection
Graft Rejection - etiology
Graft Rejection - pathology
Graft Survival
Humans
Kidney transplantation
Kidney Transplantation - adverse effects
Kidney transplants
Male
Middle Aged
monitoring: immune
Pancreas
pancreas / simultaneous pancreas‐kidney transplantation
Pancreas transplantation
Pancreas Transplantation - adverse effects
Postoperative Complications
Prognosis
Prospective Studies
rejection
Retrospective Studies
Risk Factors
Transplants & implants
Xenografts
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Summary:Simultaneous pancreas and kidney transplants offer significant therapeutic advantages but present a diagnostic approach dilemma in the diagnosis of rejection. Because both organs are from the same donor, the kidney has been treated traditionally 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 of 57 (40%) of cases with rejection; 19 of 57 (33.5%) and 15 of 57 (26.5%) showed kidney or pancreas only rejection, respectively. The degree and type of rejection differed in the majority (13 of 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 2 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 nonrejection‐related pathologies. This study on 101 concurrent pancreas and kidney biopsies in SPK patients with graft dysfunction shows a high discordant rate of rejection among grafts and supports the case for a pancreas biopsy in this setting.
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.15012