Chapter 22 - Pancreas transplantation, bioengineering, and regeneration

Abstract

Clinical presentation, epidemiology, and risk factors, means of diagnosing pancreas allograft rejection have evolved along with improvements of surgical techniques and immunosuppressive therapies. In three-quarters of pancreas transplant recipients with simultaneous pancreas-kidney (SPK) transplants, renal function monitoring and kidney biopsies are used as surrogate marker for pancreas rejection. However, in a small percentage of patients, pancreas allograft rejection can occur independently of the kidney graft and requires continued investigation. The primary means of monitoring these patients is laboratory testing (increased serum lipase and/or amylase levels), followed by ultrasound or computed tomography imaging of the abdomen to rule out surgical complications and intra-abdominal infections. Finally, a pancreas allograft biopsy must be performed. The approach to pancreas allograft biopsy (cystoscopic, percutaneous, transduodenal, laparoscopic, and duodenal) will depend on the surgical procedure (bladder-, enteric-, and gastroduodenal-drainage). Pancreas graft biopsy is the gold standard for diagnosing the type of rejection, grading the severity, and treating all types. But monitoring for pancreas rejection includes also monitoring of donor-specific antigens (DSA) and/or de novo DSAs with search of type 1 diabetic disease recurrence.