Department of Surgery, Organ Transplant Center, Riyadh, Kingdom of Saudi Arabia.
Department of Intestinal and Pancreas Transplantation, Organ Transplant Center, Riyadh, Kingdom of Saudi Arabia.
Transplantation. 2019 Mar;103(3):622-629. doi: 10.1097/TP.0000000000002412.
Histological evaluation of the pancreas graft is usually done on demand resulting in significant delays. This analysis reports on endoscopic protocol duodenal graft biopsies at regular intervals to determine feasibility, safety, and monitoring benefits.
Protocol duodenal graft biopsies in 27 consecutive pancreas transplants (10 simultaneous pancreas kidney [SPK], 17 pancreas after kidney [PAK]) with a follow-up of a minimum of 12 months were performed at days 14, 30, 90, 180, 360, 430. University of Pittsburgh Medical Center classification for intestinal rejection was used. C4d staining was performed when antibody-mediated rejection was suspected.
Overall patient and pancreas graft survival was 100% and 93% at a mean follow-up of 2.8 years. One hundred sixty-seven endoscopic biopsy procedures were performed in 27 grafts without any complication. Biopsies revealed rejection in 3 (30%) SPK recipients and in 15 (82%) of PAK recipients as early as 14 days posttransplant. Two patients underwent PAK retransplantation diagnosed with acute rejection at day 180. All except 1 recipient being treated for rejection, showed histological improvement following antirejection treatment. Following transient treatment success, a total of 3 pancreas grafts were lost for immunological reason. One loss was immediate despite antirejection treatment, 1 secondary to nonresolving rejection at 7 months and the third due to recurrent rejection 15 months posttransplantation. Additionally, biopsies detected vascular (venous thrombosis) and overimmunosuppression (cytomegalovirus infection) complications.
Protocol graft duodenal biopsies detect complications after whole-organ pancreas transplantation, are useful in guiding therapy, and carry potential for improving outcome.
胰腺移植物的组织学评估通常是按需进行的，这会导致显著的延迟。本分析报告了定期进行内镜下十二指肠移植物活检的方案，以确定其可行性、安全性和监测益处。
对 27 例连续胰腺移植（10 例胰肾联合移植[SPK]，17 例肾后胰腺移植[PAK]）进行了方案性十二指肠移植物活检，随访时间至少 12 个月，分别在术后第 14、30、90、180、360 和 430 天进行。采用匹兹堡大学医学中心的肠道排斥反应分类标准。当怀疑存在抗体介导的排斥反应时，进行 C4d 染色。
在平均 2.8 年的随访中，患者和胰腺移植物的总存活率为 100%和 93%。在 27 个移植物中进行了 167 次内镜活检，无任何并发症。活检显示，在移植后 14 天内，3 例（30%）SPK 受者和 15 例（82%）PAK 受者发生了排斥反应。2 例 PAK 受者在移植后 180 天被诊断为急性排斥反应，并进行了再次移植。除 1 例因排斥反应接受治疗的受者外，所有受者在接受抗排斥治疗后，组织学均有所改善。在短暂的治疗成功后，共有 3 个胰腺移植物因免疫原因丢失。1 例尽管进行了抗排斥治疗，但仍立即丢失，1 例因 7 个月时未解决的排斥反应而丢失，第 3 例因移植后 15 个月时再次发生排斥反应而丢失。此外，活检还发现了血管（静脉血栓形成）和过度免疫抑制（巨细胞病毒感染）并发症。
全器官胰腺移植后，方案性移植物十二指肠活检可检测并发症，有助于指导治疗，并有可能改善预后。
