Solitary pancreas allografts. The role of percutaneous biopsy and standardized histologic grading of rejection.

OBJECTIVE

To determine the potential impact of ultrasound-guided percutaneous pancreas allograft biopsy and standardized histologic grading on graft and patient survival in a solitary pancreas transplant program.

DESIGN

Retrospective case series survey.

SETTING

Tertiary care, university teaching hospital.

PATIENTS

Thirty-five recipients of solitary pancreas transplants.

INTERVENTIONS

Percutaneous pancreas allograft biopsies were performed in solitary pancreas transplant recipients.

MAIN OUTCOME MEASURES

Actuarial graft and patient survival, cause of graft loss.

RESULTS

Initiation of ultrasound-guided percutaneous pancreas allograft biopsy with standardized histologic grading is associated with a 70% 1-year graft survival and 93% 1-year patient survival in solitary pancreas transplantation. Acute rejection was responsible for only 11% of cases of graft loss. The presence of endotheliitis, vasculitis, or confluent acinar necrosis is associated with decreased pancreas allograft survival, poor response to corticosteroid therapy, and shortened time interval to ultimate graft loss. Clinical criteria for acute rejection such as elevated serum amylase or lipase levels, 50% decrease in urinary amylase levels, unexplained fever, or hyperglycemia are associated with a positive predictive value of only 72%.

CONCLUSION

Pancreas allograft biopsy and standardized histologic grading are associated with significantly improved 1-year graft and patient survival in solitary pancreas transplantation.