CORRELATION WITH KIDNEY ALLOGRAFT REJECTION IN SIMULTANEOUS PANCREAS KIDNEY TRANSPLANTS
Animal studies in pigs and dogs have demonstrated that in general the histological changes in one of the two grafts (kidney or pancreas) cannot predict the findings in the other organ. In a large clinical study based on the examination of pancreas and kidney needle core biopsies, simultaneous pancreas and kidney rejection occurred in 73% of cases, whereas kidney-only rejection occurred in 23% and pancreas-only rejection in 3%. The non-specificity of laboratory and clinical findings for the diagnosis of acute rejection in the pancreas has been emphasized in the context of simultaneous kidney-pancreas transplants and for pancreas transplants alone. In the past, significant value has been given to increase in serum creatinine as a surrogate marker for acute pancreas rejection, interestingly, one study has described renal allograft rejection in association with increase in pancreatic enzymes, suggesting a concurrent pancreas rejection.
The need to accurately diagnose renal and pancreas rejection independently of each other is evident in the case of patients receiving a cadaveric pancreas simultaneously with a kidney from a living donor (SPLK).
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