Discordant rejection in simultaneous pancreas and kidney transplantation: true discordance or analysis artefact?

Assalino, Michela; Hadaya, Karine; Andrès, Axel; Berney, Thierry

doi:10.1111/tri.13017

Cited by 6 publications

(1 citation statement)

References 13 publications

(12 reference statements)

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“…A study by Uva et al showed that a positive renal biopsy for rejection correctly predicts pancreatic rejection in 86% of cases with concurrent pancreatic dysfunction, albeit they also did not stratify by presence of DSA [ 18 ]. Furthermore, there is debate whether discordancy truly exists or whether it’s merely a matter of time [ 19 , 20 ]. Our report illustrates the timely development from a single episode of clinical pancreatitis with DSA formation to recurrent pancreatitis, to eventually kidney transplant dysfunction with biopsy proven chronic mixed type ABMR and a biopsy-proven panniculitis to underscore the likelihood of chronic pancreas rejection.…”

Section: Discussionmentioning

confidence: 99%

Chronic Pancreas Allograft Rejection Followed by Successful HLA-Incompatible Islet Alloautotransplantation: A Novel Strategy?

Veltkamp,

Nijhoff,

van den Broek

et al. 2023

Transpl Int

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The purpose of pancreas or islet transplantation is to restore glycemic control in order to mitigate diabetes-related complications and prevent severe hypoglycemia. Complications from chronic pancreas allograft rejection may lead to transplantectomy, even when the endocrine function remains preserved. We present first evidence of a successful HLA incompatible islet re-transplantation with islets isolated from a rejecting pancreas allograft after simultaneous kidney pancreas transplantation. The pancreas allograft was removed because of progressively painful pancreatic panniculitis from clinically uncontrolled chronic rejection. The endocrine function was preserved. Induction treatment for this “islet alloautotransplantation” consisted of plasmapheresis, IVIg and alemtuzumab. At 1 year, the patient retained islet graft function with good glycemic control and absence of severe hypoglycemia, despite persistent low-grade HLA donor-specific antibodies. His panniculitis had resolved completely. In our point of view, islet alloautotransplantation derived from a chronically rejecting pancreas allograft is a potential option to salvage (partial) islet function, despite preformed donor-specific antibodies, in order to maintain stable glycemic control. Thereby it protects against severe hypoglycemia, and it potentially mitigates kidney graft dysfunction and other diabetes-related complications in patients with continued need for immunosuppression and who are otherwise difficult to retransplant.

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Section: Discussionmentioning

confidence: 99%