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Pancreas allograft rejection

Authors
Tarek Alhamad, MD, MS, FACP, FASN
Aleksandra Kukla, MD
Robert J Stratta, MD
Section Editors
Daniel C Brennan, MD, FACP
David M Nathan, MD
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

The outcomes of vascularized pancreas transplantation have steadily improved secondary to improvements in surgical techniques, donor and recipient selection and management, and diagnostic imaging, all of which have resulted in a reduction in early technical graft losses. In addition, advances in immunosuppression and immune monitoring have led to a commensurate decrease in immunological graft losses. However, pancreas allograft rejection remains a major clinical challenge and is the primary cause of death-censored pancreas allograft loss after three months posttransplant.

At present, approximately three-quarters of pancreas transplants in the United States are performed as simultaneous pancreas-kidney (SPK) transplants, with the remainder performed as either sequential pancreas after kidney transplant (PAK, 16 percent) or pancreas transplants alone (PTA, 9 percent) [1].

This topic reviews the epidemiology, clinical presentation, diagnosis, treatment, and prognosis of acute rejection of the pancreas allograft in the setting of SPK transplantation. However, this discussion is also applicable to pancreas allograft rejection in PAK and PTA recipients.

The selection of patients, induction, and maintenance immunosuppressive therapies are discussed elsewhere. (See "Patient selection for and immunologic issues relating to kidney-pancreas transplantation in diabetes mellitus".)

The benefits and complications (other than rejection) associated with these procedures and the roles of PTA and islet transplantation in diabetic patients without renal failure are discussed separately. (See "Benefits and complications associated with kidney-pancreas transplantation in diabetes mellitus" and "Pancreas and islet transplantation in diabetes mellitus".)

                        

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 15 00:00:00 GMT 2016.
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References
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