Background: Pancreas transplant loss is primarily driven by acute and chronic rejection, with antibody-mediated rejection (AMR) being particularly associated with worse outcomes. Currently, the prognostic factors predicting a positive treatment response, including clinical, biochemical, and histological features, remain unclear. Aim of the study: This study aimed to analyze pancreas transplant recipients (SPK, PAK, PTA) with rejection, focusing on identifying predictive factors for graft survival and therapy response, with particular emphasis on specific histological features. Methods: A single-center, retrospective study of 44 patients with biopsy-proven pancreas rejection was conducted. Patients were divided into graft loss or survival groups. Characteristics at transplant and rejection were analyzed, with histological diagnoses based on BANFF criteria at the time of biopsy. Results: SPK transplantation were positively correlated with graft survival, while use of CNIs and presence of higher blood glucose levels were associated with graft failure. Acute endothelialitis occurred in 41% of poor outcomes versus 14% in better outcomes, acinar necrosis in 27% of poor outcomes, and chronic rejection in 58%, with chronic arteriopathy in 23%. Isolated C4d positivity and DSAs were not significantly associated with AMR diagnosis or poor prognosis, but almost all cases of AMR and mixed rejection showed widespread C4d positivity along with the presence of DSAs. Kidney biopsies in SPK cases showed limited concordance with pancreas biopsies. Conclusions: Pancreas biopsy remains critical for diagnosing and prognosticating rejection, particularly in SPK cases where kidney biopsy is insufficient. SPK transplantation and CNIs-free protocols may offer protective benefits. Clinical hyperglycemia signals severe parenchymal damage, and poor prognosis may be linked to histological features of: endothelialitis, acinar necrosis, and chronic-active rejection with vasculopathy. In line with the literature, the presence of C4d+ and DSAs can guide the diagnosis of AMR that is confirmed to be associated with poor prognosis. Further multivariate analysis is needed to confirm these findings.
Background: Pancreas transplant loss is primarily driven by acute and chronic rejection, with antibody-mediated rejection (AMR) being particularly associated with worse outcomes. Currently, the prognostic factors predicting a positive treatment response, including clinical, biochemical, and histological features, remain unclear. Aim of the study: This study aimed to analyze pancreas transplant recipients (SPK, PAK, PTA) with rejection, focusing on identifying predictive factors for graft survival and therapy response, with particular emphasis on specific histological features. Methods: A single-center, retrospective study of 44 patients with biopsy-proven pancreas rejection was conducted. Patients were divided into graft loss or survival groups. Characteristics at transplant and rejection were analyzed, with histological diagnoses based on BANFF criteria at the time of biopsy. Results: SPK transplantation were positively correlated with graft survival, while use of CNIs and presence of higher blood glucose levels were associated with graft failure. Acute endothelialitis occurred in 41% of poor outcomes versus 14% in better outcomes, acinar necrosis in 27% of poor outcomes, and chronic rejection in 58%, with chronic arteriopathy in 23%. Isolated C4d positivity and DSAs were not significantly associated with AMR diagnosis or poor prognosis, but almost all cases of AMR and mixed rejection showed widespread C4d positivity along with the presence of DSAs. Kidney biopsies in SPK cases showed limited concordance with pancreas biopsies. Conclusions: Pancreas biopsy remains critical for diagnosing and prognosticating rejection, particularly in SPK cases where kidney biopsy is insufficient. SPK transplantation and CNIs-free protocols may offer protective benefits. Clinical hyperglycemia signals severe parenchymal damage, and poor prognosis may be linked to histological features of: endothelialitis, acinar necrosis, and chronic-active rejection with vasculopathy. In line with the literature, the presence of C4d+ and DSAs can guide the diagnosis of AMR that is confirmed to be associated with poor prognosis. Further multivariate analysis is needed to confirm these findings.
Risk factors for pancreas survival: what about histology?
VIOLA, LUDOVICA
2022/2023
Abstract
Background: Pancreas transplant loss is primarily driven by acute and chronic rejection, with antibody-mediated rejection (AMR) being particularly associated with worse outcomes. Currently, the prognostic factors predicting a positive treatment response, including clinical, biochemical, and histological features, remain unclear. Aim of the study: This study aimed to analyze pancreas transplant recipients (SPK, PAK, PTA) with rejection, focusing on identifying predictive factors for graft survival and therapy response, with particular emphasis on specific histological features. Methods: A single-center, retrospective study of 44 patients with biopsy-proven pancreas rejection was conducted. Patients were divided into graft loss or survival groups. Characteristics at transplant and rejection were analyzed, with histological diagnoses based on BANFF criteria at the time of biopsy. Results: SPK transplantation were positively correlated with graft survival, while use of CNIs and presence of higher blood glucose levels were associated with graft failure. Acute endothelialitis occurred in 41% of poor outcomes versus 14% in better outcomes, acinar necrosis in 27% of poor outcomes, and chronic rejection in 58%, with chronic arteriopathy in 23%. Isolated C4d positivity and DSAs were not significantly associated with AMR diagnosis or poor prognosis, but almost all cases of AMR and mixed rejection showed widespread C4d positivity along with the presence of DSAs. Kidney biopsies in SPK cases showed limited concordance with pancreas biopsies. Conclusions: Pancreas biopsy remains critical for diagnosing and prognosticating rejection, particularly in SPK cases where kidney biopsy is insufficient. SPK transplantation and CNIs-free protocols may offer protective benefits. Clinical hyperglycemia signals severe parenchymal damage, and poor prognosis may be linked to histological features of: endothelialitis, acinar necrosis, and chronic-active rejection with vasculopathy. In line with the literature, the presence of C4d+ and DSAs can guide the diagnosis of AMR that is confirmed to be associated with poor prognosis. Further multivariate analysis is needed to confirm these findings.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/81457