Causes of Graft Dysfunction: Non-Rejection


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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  2. Gruessner RW, Nakhleh R, Tzardis P et al.: Differences in rejection grading after simultaneous pancreas and kidney transplantation in pigs. Transplantation 1994;57:1021-8.
  3. Hawthorne WJ, Allen RD, Greenberg ML, et al.: Simultaneous pancreas and kidney transplant rejection: separate or synchronous events? Transplantation 1997;63:352-8.
  4. Tesi RJ, Henry ML, Elkhammas EA, Davies EA, Ferguson RM: The frequency of rejection episodes after combined kidney-pancreas transplant - the impact on graft survival. Transplantation 1994;58:424-30.
  5. Klassen DK, Hoehn-Saric EW, Weir MT, et al.: Isolated pancreas rejection in combined kidney pancreas transplantation. Results of percutaneous pancreas biopsy. Transplantation 1996;61:974-7.
  6. Shapiro R, Jordan ML, Scantlebury WP, et al.: Renal allograft rejection with normal renal function in simultaneous kidney/pancreas recipients: does dissynchronous rejection really exist? Transplantation 2000;69:440-1.

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Last Modified: Thu Jun 18 10:14:08 EDT 2009


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