Department of Transplantation Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Am J Transplant. 2018 May;18(5):1256-1261. doi: 10.1111/ajt.14658. Epub 2018 Feb 3.
The surgical technique with duodeno-duodenal enteroanastomosis of pancreas transplants allows for representative endoscopic ultrasound-guided needle biopsies of the donor duodenum and the pancreas graft. We assessed whether histological findings in transplanted donor duodenal biopsies can indicate rejection in the transplanted pancreas. Since September 2012, a duodeno-duodenal enteroanastomosis has been the default technique for pancreas transplantations at our center. In 67 recipients we prospectively examined 113 endoscopic ultrasound-guided procedures with representative biopsies from the duodenum grafts and the pancreas grafts (97 per protocol and 16 on indication). All graft biopsies were evaluated according to established rejection criteria. A total of 22 biopsy-proven pancreas rejections were detected, with 2 matching duodenal biopsies showing rejection. This gives a sensitivity of 9% for detection of a pancreas rejection by duodenal biopsies. The other matching duodenal biopsies were either normal (n = 13) or indeterminate (n = 7). Rejection of the donor duodenum was found in only 6/113 biopsies, with 2 concurrent pancreas rejections. In conclusion, the donor duodenum is not a useful reporter organ for rejection in the pancreas graft.
胰腺移植的十二指肠-十二指肠肠内吻合术使得可以对供体十二指肠和胰腺移植物进行有代表性的内镜超声引导下针吸活检。我们评估了移植供体十二指肠活检中的组织学发现是否可以指示移植胰腺中的排斥反应。自 2012 年 9 月以来，十二指肠-十二指肠肠内吻合术一直是我们中心胰腺移植的默认技术。在 67 名受者中，我们前瞻性地检查了 113 例代表供体十二指肠和胰腺移植物的内镜超声引导程序（97 例符合方案，16 例因适应症）。所有移植物活检均根据既定的排斥反应标准进行评估。总共检测到 22 例经活检证实的胰腺排斥反应，其中 2 例与十二指肠活检显示排斥反应相匹配。这表明十二指肠活检检测胰腺排斥反应的敏感性为 9%。其他匹配的十二指肠活检要么正常（n=13），要么不确定（n=7）。仅在 6/113 例活检中发现供体十二指肠排斥反应，其中 2 例并发胰腺排斥反应。总之，供体十二指肠不是胰腺移植物排斥反应的有用报告器官。
