Pancreas Transplant Recipients Research Articles

The Utility of Procalcitonin in the Management of Kidney and Pancreas Transplant Recipients with Suspected Infection

The Utility of Procalcitonin in the Management of Kidney and Pancreas Transplant Recipients with Suspected Infection

Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study.

Sarcopenia has been identified as a predictive variable for surgical outcomes. We hypothesized that sarcopenia could be a key measure to identify frail patients and potentially predict poorer outcomes among recipients of simultaneous pancreas and kidney (SPK) transplants. We estimated sarcopenia by measuring psoas muscle mass index (PMI). PMI was assessed on perioperative computed tomography (CT) scans of SPK recipients. Of the 141 patients identified between 2010 and 2018, 107 had a CT scan available and were included in the study. The median follow-up was 4 years (range, 0.5-9.1 y). Twenty-three patients had a low PMI, and 84 patients had a normal PMI. Patient characteristics were similar between the 2 groups except for body mass index, which was significantly lower in low PMI group (P < 0.001). Patient and kidney graft survival were not statistically different between groups (P = 0.851 and P = 0.357, respectively). A multivariate Cox regression analysis showed that patients with a low PMI were 6 times more likely to lose their pancreas allograft (hazard ratios, 5.4; 95% confidence intervals, 1.4-20.8; P = 0.015). Three out of 6 patients lost their pancreas graft due to rejection in the low PMI group, compared with 1 out of 9 patients in the normal PMI group. Among low PMI patients who had a follow-up CT scan, 62.5% (5/8) of those with a functional pancreas graft either improved or resolved sarcopenia, whereas 75.0% (3/4) of those who lost their pancreas graft continued to lose muscle mass. Sarcopenia could represent one of the predictors of pancreas graft failure and should be evaluated and potentially optimized in SPK recipients.

Kidney and pancreas transplant recipients undergoing cholecystectomy experience superior outcomes in transplant centers

BackgroundThis retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients and the general population undergoing cholecystectomy. MethodsMultivariate logistic regression and linear regression tests computed odds ratios (OR) and coefficients of the linear regression by analyzing weighted data from the NIS database between 2005 and 2014 to identify differences in mortality, morbidity, length of stay (LOS) and costs amongst KTx, PTx, PKTx, and non-Tx undergoing cholecystectomy in all centers and transplant centers. ResultsOverall 6007 KTx, 164 PTx, 535 PKTx, and 4,207,241 non-Tx met the inclusion criteria. Mortality from cholecystectomy was 1.0%. Transplant recipients did not experience a significant increase in mortality. However KTx and PTx suffered increased morbidity risks (KTx OR1.244 p < 0.01; PTx OR2.165 p < 0.01) compared to non-Tx. However transplant recipients did not incur an increased morbidity risk in transplant centers. ConclusionTransplant recipients undergoing cholecystectomy should be counseled about their increased complication risks. Surgeons should consider transferring KTx and PTx to transplant centers for their cholecystectomy procedure to mitigate these risks.

Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States.

National data on patient characteristics, treatment, and outcomes of critically ill coronavirus disease 2019 (COVID‐19) solid organ transplant (SOT) patients are limited. We analyzed data from a multicenter cohort study of adults with laboratory‐confirmed COVID‐19 admitted to intensive care units (ICUs) at 68 hospitals across the United States from March 4 to May 8, 2020. From 4153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non‐SOT patients. We used a binomial generalized linear model (log‐binomial model) to examine the association of SOT status with death and other clinical outcomes. Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black. Death within 28 days of ICU admission was similar in SOT and non‐SOT patients (40% and 43%, respectively; relative risk [RR] 0.92; 95% confidence interval [CI]: 0.70‐1.22). Other outcomes and requirement for organ support including receipt of mechanical ventilation, development of acute respiratory distress syndrome, and receipt of vasopressors were also similar between groups. There was a trend toward higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non‐SOT patients (37% vs. 27%; RR [95% CI]: 1.34 [0.97‐1.85]). Death and organ support requirement were similar between SOT and non‐SOT critically ill patients with COVID‐19.

Small Bowel Perforation as the Initial Manifestation of Post-Transplant Lymphoproliferative Disorder in a Kidney and Pancreas Transplant Recipient: A Case Report

Post-transplant lymphoproliferative disorder (PTLD) comprises a broad spectrum of diseases and is a rare but serious complication of solid organ transplantation. We report the case of a 45-year-old simultaneous pancreas and kidney (SPK) transplant recipient with diffuse, early-onset PTLD, manifesting as jejunal perforation at 6 months after transplantation. The patient underwent urgent small bowel resection of the affected portion of jejunum. The surgical pathology report was significant for diffuse large B-cell lymphoma. Subsequently, the patient underwent a full workup, including upper and lower endoscopy and whole-body positron emission tomography that revealed involvement of the axial skeleton and multiple abdominal organs with sparing of the grafts. He was treated with rituximab and intrathecal methotrexate for central nervous system prophylaxis. The patient experienced complete resolution of disease by positron emission tomography 8 months after initial presentation. We found no previous report in the literature of intestinal perforation as the initial presentation of PTLD in SPK transplant recipients.

Induction and Immunosuppressive Management of Pancreas Transplant Recipients.

Despite improved overall outcomes, rejection continues to occur frequently after pancreas transplantation. To review the literature and to provide a state-of-the-art assessment of current practice and developments of immunosuppressive regimens in pancreas transplantation. The literature was reviewed and relevant articles were retrieved and analyzed. Induction therapy is used in approximately 90% of the transplants, with T-cell depleting antibodies being the prevalent therapy (>90%). Despite the initial enthusiasm on steroid-free regimens, maintenance protocols continue to be mostly based on a combination of steroids, tacrolimus, and mycophenolate mofetil. Tacrolimus is used in the majority of recipients. Sirolimus is rarely used at the time of transplant and is introduced later on in approximately 10% of the recipients, mostly in the context of a switching strategy to address the side effects of calcineurin inhibitors. The overall quality of published studies was quite low, because of the retrospective design, the heterogeneity of study groups with respect to PTx categories, the inclusion of mixed recipient categories with respect to immunologic risk profile, and the use of non-standardized concurrent immunosuppressive therapies. In addition, most reported studies were clearly underpowered, and treatment outcomes were not standardized. Since approximately two decades, immunosuppression in pancreas transplantation mostly consists of induction with depleting antibodies and maintenance therapy using a combination of steroids, tacrolimus, and mycophenolate mofetil. While true novelty would be very much needed, this review confirms the wide use and the clinical efficacy of this regimen.

THE TISSUE COMMON RESPONSE MODULE (TCRM) SCORE PROVIDES A QUANTITATIVE OBJECTIVE BIOPSY SCORE TO ASSESS THE SEVERITY OF PANCREAS TRANSPLANT REJECTION

Introduction: Several studies have used gene expression profiling to identify key immunologic and inflammatory markers in the blood and tissue of solid-organ transplant recipients experiencing rejection (AR), but none of these have included samples from pancreas transplant (PT) recipients. Gene expression analysis of public transcriptional data from kidney, heart, liver, and lung transplant rejection led to the tissue Common Response Module (tCRM) score based on 11 genes (BASP1, ISG20, PSMB9, RUNX3, TAP1, NKG7, LCK, INPP5D, CXCL9, CD6, CXCL10; Khatri et al, 2013) which can diagnose the severity of tissue rejection, but this has not been validated in PT. In this study, we aimed to evaluate the locked tCRM score and identify additional markers of PT-AR. Materials and Methods: We performed a retrospective study applying gene expression analysis to RNA isolated from formalin-fixed paraffin-embedded (FFPE) tissue from 51 pancreas biopsies, grouped by histopathologic grade of acute cellular rejection (Grade 1 (n=14), Grade 2 (n=14), and Grade 3 (n=9)) versus normal (n=14). Gene expression analysis was performed using the Nanostring Cancer Immune v1.1 oligonucleotide set, which includes 40 set housekeeping (HK) genes. Appropriate HK genes were selected, data was log transformed and normalized. Differential gene expression (DE) analysis involved a negative binomial model, unsupervised hierarchical clustering, and calculation of the tCRM score with removal of Nanostring designated HK genes confounded by rejection. P-value was considered significant at <0.05 (Benjamini-Yekutieli, Mann-Whitney, Graph-Pad PRISM). Pathway analysis (PA) was performed to evaluate biological significance. Results: Some Nanostring designated HK genes showed significant differences with AR and hence a custom set of HK genes was used for normalization of log transformed data. Significant transcriptional differences were seen with higher grades of rejection in PT (Fig.1). The tCRM score, run on a sub-component of 11 genes, captures the same message with a scaled score that increases across rejection grades (Fig.2). Of the 22 genes differentially expressed in Grade 3, 18 were also significant in Grade 2. Specifically, within the 11 tCRM genes diagnostic of rejection in other solid organ transplants, 9 of 11 were significant for PT rejection, with the last two tCRM gene (CXCL9 and CXCL10) approaching significance at p=0.055 and 0.08 respectively. Conclusion: This study shows that a common hub of immune mediated genes, highly significant in transplant rejection (tCRM), and not confounded by tissue source (kidney, heart, liver and lung), were also highly informative for diagnosis and quantification of AR injury in PT. The bulk of the AR signal in PT, similar to other solid organs, is attributable to infiltration of activated leukocytes in the tissue, with background tissue injury specific transcriptional changes. The clinical and molecular drivers for Grade 1 PT rejection deserve additional analysis.Fig. 1.

Changes in quality of life, health status and other patient-reported outcomes following simultaneous pancreas and kidney transplantation (SPKT): a quantitative and qualitative analysis within a UK-wide programme.

We examined quality of life (QoL) and other patient-reported outcome measures (PROMs) in 95 simultaneous pancreas and kidney transplant (SPKT) recipients and 41 patients wait-listed for SPKT recruited to the UK Access to Transplantation and Transplant Outcome Measures (ATTOM) programme. Wait-listed patients transplanted within 12months of recruitment (n=22) were followed 12months post-transplant and compared with those still wait-listed (n=19) to examine pre- to post-transplant changes. Qualitative interviews with ten SPKT recipients 12months post-transplant were analysed thematically. Cross-sectional analyses showed several better 12-month outcomes for SPKT recipients compared with those still wait-listed, a trend to better health utilities but no difference in diabetes-specific QoL or diabetes treatment satisfaction. Pre- to post-transplant, SPKT recipients showed improved treatment satisfaction, well-being, self-reported health, generic QoL and less negative impact on renal-specific QoL (ps<0.05). Health utility values were better overall in transplant recipients and neither these nor diabetes-specific QoL changed significantly in either group. Pre-emptive transplant advantages seen in 12-month cross-sectional analyses disappeared when controlling for baseline values. Qualitative findings indicated diabetes complications, self-imposed blood glucose monitoring and dietary restrictions continued to impact QoL negatively post-transplant. Unrealistic expectations of SPKT caused some disappointment. Measuring condition-specific PROMs over time will help in demonstrating the benefits and limitations of SPKT.

Alloimmunity in pancreas transplantation.

Despite significant improvement in pancreas allograft survival, rejection continues to be a major clinical problem. This review will focus on emerging literature related to the impact of pretransplant and de-novo DSA (dnDSA) in pancreas transplant recipients, and the diagnosis and treatment of T-cell-medicated rejection (TCMR) and antibody-mediated rejection (ABMR) in this complex group of patients. Recent data suggest that pretransplant DSA and the emergence of dnDSA in pancreas transplant recipients are both associated with increased risk of ABMR. The pancreas allograft biopsy is essential for the specific diagnosis of TCMR and/or ABMR, distinguish rejection from other causes of graft dysfunction, and to guide-targeted therapy. This distinction is important especially in the setting of solitary pancreas transplants but also in simultaneous pancreas-kidney transplants where solid evidence has now emerged demonstrating discordant biopsy findings. Treatment of rejection in a functioning pancreas can prolong allograft survival. The accurate and timely diagnosis of active alloimmune destruction in pancreas transplant recipients is paramount to preserving graft function in the long term. This review will discuss new, rapidly evolving information that is valuable for the physician caring for these patients to achieve optimal immunological outcomes.

Antibody immunosuppression for pancreas and kidney-pancreas transplant recipients

Antibody immunosuppression for pancreas and kidney-pancreas transplant recipients

COVID-19 in pancreas transplant recipients.

Coronavirus disease 2019 (COVID‐19) has become a pandemic since first being described in January 2020. Clinical manifestations in non‐transplant patients range from asymptomatic infection to severe pneumonia with acute respiratory distress syndrome, multiorgan system failure, and death. Limited reports in kidney transplant recipients suggest similar characteristics in that population. We report here the first case series of COVID‐19 infection occurring in pancreas transplant recipients.

Correlation of intraoperative donor duodenal-segment swab cultures with the subsequent occurrence of surgical site infections in kidney and pancreas transplant recipients.

Pancreas transplantation is employed for the treatment of type I diabetes mellitus. It is postulated that surgical site infection (SSI), particularly organ-space infections, after pancreas transplantation may arise from microbial contamination arising from the donor duodenal segment. Therefore, some centers have adopted the practice of culturing the donor duodenal segment and subsequently administering antimicrobial therapy to the recipient directed at the microorganisms isolated to prevent SSI. In this retrospective cohort study, we evaluated the correlation between positive donor duodenal-segment cultures and SSIs in the recipients. Data were recorded and analyzed to assess the correlation of the organisms isolated in the donor duodenal cultures with those producing SSI in the recipients. We evaluated 379 consecutive pancreas transplant recipients from January 2000 to December 2015. Donor duodenal swab cultures were performed at the time of pancreas transplantation, and 206 (54.3%) were positive. SSIs occurred in 51 of the 206 recipients (24.8%) with positive duodenal-segment cultures and in 41 of 173 individuals (23.7%) with negative cultures (P = .81; r = 0.00). Notably, deep and organ-space SSIs were observed in 27 of 206 of the positive duodenal culture groups (13.1%) versus 29 of 173 of the negative duodenal culture groups (16.8%; P = 0.31; r = -0.059). No differences were detected in the pathogens producing SSIs between the group with a positive duodenal swab versus the group with a negative swab. Microorganisms producing SSIs matched those found in the positive donor duodenal cultures in only 15 patients (7.8%). Although positive cultures from the donor duodenal segment prompted the administration of antimicrobial therapy in the recipient directed against the pathogen isolated, this practice did not reduce SSIs compared with those transplant recipients with culture-negative duodenal swabs. In addition, the organisms isolated from the donor duodenal segment were not predictive of subsequent SSI.

121-OR: Immunosuppressant-Related Quality of Life and Lifestyle of Insulin Independent T1D Pancreas Transplant Recipients

Background: Pancreas Transplantation (PT) provides insulin independence and improves quality of life in patients with type 1 diabetes (T1D). However, PT recipients require lifelong immunosuppression resulting in immunosuppression related side-effects. Methods: After IRB approval, we prospectively studied 15 PT recipients at least 1 year after PT. Subjects completed DEXA for body composition, actigraph for 1 week, the modified Transplant symptom occurrence and distress scale (MTSOSD) and VioFFQ - VIOCARE Food Frequency questionnaires. Results: PT recipient were 53.1 ± 10.6 years old, 12F, BMI (Kg/m2) 30.8 ± 6, 33 ± 12.3 years of T1D and 6 ± 5 years (1-17years) time interval from PT. Lab values were HbA1c 5.4 ± 0.6 %, fructosamine 233 ± 27 µmol/L, fasting glucose 94.3 ± 17.5 mg/dl, C-peptide 2.5 ± 0.9 ng/ml and eGFR 56.3 ± 25.5 ml/min. DEXA revealed 41.1 ± 8.3 % total fat with 41.2 ± 10.2 % in Arms, 39.0 ± 9.8 % Legs and 43.7 ± 10.3 % Trunk. Actigraph revealed 1.6 ± 0.3 MET rate, 13428.7 ± 4649.0 average steps/day and 58.1 ± 12.9 % in Sedentary, 26.3 ± 7.3 % in Light and 15.6 ± 6.2 % in moderate grade physical activity respectively . Viocare revealed 81.9% calories of Estimated Energy Requirement with 44.9 ± 7.1 % CHO, 36.7 ± 5.6 % total Fat, 13.5 ± 3.2 % saturated fat and 17.9 ± 3.1 % protein calories with Omega-3 and dietary fiber intake 0.1 ± 0.11 g and 23.1 ± 9.1 g respectively. On MTSOSD, at least one side effect (SE) was reported by every subject with range varying from 1 to 53 SE out of 59 in the questionnaire. Four (33%) subjects reported at least one grade 4 symptom (high distress); 1 reported grade 4 for 24 items out of 59 in questionnaire and the other 3 grade 4 for 1.7 ± 1.2 symptoms. For grade of symptoms ranging from 0 to 3, 30 ± 14 SE were reported by the 12 subjects. Conclusions: PT recipients that are insulin independent for long periods of time have suboptimal body composition and some immunosuppression related SE but perform better than average physical activity. Disclosure R. Kaur: None. C. Reid: None. S. Rizvi: None. S. Batthula: None. S.K. McCrady-Spitzer: None. B.H. Smith: None. W.K. Kremers: Research Support; Self; AstraZeneca. P. Dean: None. A. Kukla: None. M.D. Stegall: None. Y.C. Kudva: Research Support; Self; Dexcom, Inc., Roche Diabetes Care. Other Relationship; Self; Abbott.

363-OR: Comprehensive Assessment of Glycemic Control after Pancreas Transplantation

Introduction: Limited data are available about comprehensive metabolic evaluation after Pancreas transplantation (PT) for type 1 diabetes (T1D). Methods: After IRB approval, we prospectively studied 15 PT recipients at least 1 year post transplant. After a screening visit, subjects underwent Dexcom G4 CGM for one week and Mixed Meal Test (MMT) according to standard procedure. Results: PT recipient were 53.1 ± 10.6 years old, F/M 12/3, BMI (Kg/m2) 30.8 ± 6 and mean duration of diabetes was 33 ± 12.3 years with 6 ± 5 (1-17) years mean interval from PT to the study. Twelve patients underwent pancreas transplant alone and three underwent simultaneous pancreas kidney transplantation. Baseline values were Hemoglobin 12.3 ± 1.4 (g/dl), HbA1c 5.4 ± 0.6 %, Albumin 4.0 ± 0.3 g/dl, Fructosamine 233 ± 27 (µmol/L), Fasting Glucose 94.3 ± 17.5 mg/dl, C-peptide 2.5 ± 0.9 (ng/ml), eGFR 56.3 ± 25.5 ml/min and AST 23.4 ± 8.5 U/L. MMT revealed Glucose concentration increased from 90.9 ± 9.6 mg/dl at baseline to 140.6 ± 41.5 mg/dl at 30min followed by 123.2 ± 48.0 mg/dl and 115.2 ± 34.6 mg/dl at 60mins and 120 mins respectively. C-peptide was 2.4 ± 0.7 ng/ml at baseline, peaked to 7.5 ± 5.4 ng/ml at 60 mins and was 6.0 ± 3.6 mins and 5.9 ± 2.4 at 30 and 120 mins respectively with insulin peaking from 13.5 ± 5.5 uIU/ml at baseline to 107 ± 81.6 uIU/ml at 30 mins and 85.8 ± 78 uIU/ml and 42.2 ± 23.2 uIU/ml at 60 mins and 120 mins respectively. CGM analysis revealed mean CGM glucose was 120.4 ± 14.8 with SD 26.2 ± 7.7. Glucose control was excellent with 94 ± 9.2% of readings within 70-180mg/dl and 79.8 ± 17.6% within 70-140 mg/dl. Percentage time &amp;lt; 70 mg/dl and &amp;lt; 54 mg/dl were 1.1 ± 1.1% and 0.1 ± 0.4% respectively. Percentage time &amp;gt; 180 and &amp;gt; 250 mg/dl were 4.8 ± 9.3% and 0.4 ± 0.7% respectively. HBGI, LBGI and ADRR were 1.3 ± 1.6, 0.7 ± 0.5 and 17.4 ± 8.9 respectively. Conclusion: PT recipients demonstrate excellent glucose control on comprehensive assessment one or more years after the procedure. CGM and MMT data are different from normal people. Disclosure R. Kaur: None. C. Reid: None. P. Thapa: None. S. Rizvi: None. S.K. McCrady-Spitzer: None. S. Batthula: None. B.H. Smith: None. P. Dean: None. W.K. Kremers: Research Support; Self; AstraZeneca. A. Kukla: None. M.D. Stegall: None. Y.C. Kudva: Research Support; Self; Dexcom, Inc., Roche Diabetes Care. Other Relationship; Self; Abbott.

269 Rare Case of Pulmonary Necrotic Rhodococcus Equi Infection in a Kidney Pancreas Transplant Recipient.

269 Rare Case of Pulmonary Necrotic Rhodococcus Equi Infection in a Kidney Pancreas Transplant Recipient.

Outcomes of pancreas transplantation in older diabetic patients

ObjectiveImprovement in insulin alternatives is leading to a delayed presentation of microvascular and macrovascular complications of diabetes. The objective of this study was to evaluate the long-term outcomes of older...

The use of LCP-Tacrolimus (Envarsus XR) in simultaneous pancreas and kidney (SPK) transplant recipients

BackgroundExtended release LCP-tacrolimus (LCPT) allows once-daily dosing in transplant recipients. The improved bioavailability may be beneficial for simultaneous pancreas-kidney recipients (SPK). MethodsThis is a study of 39 SPK recipients on standard immediate-release tacrolimus (IR-TAC, n = 21) or LCPT (n = 18). Coefficient of variability (CV = 100∗standard deviation/mean) was calculated to assess drug levels. Hemoglobin A1c (HbA1c), tacrolimus and creatinine levels were measured postoperatively. ResultsThere was no difference in tacrolimus CV in the IR-TAC and LCPT groups at 1 month or 3 months postoperatively; however, a greater difference was observed at 1 year (41.0 vs. 33.1%; p = 0.19). There were six episodes of acute rejection in the IR-TAC group compared to zero episodes in the LCPT group (p = 0.01). HbA1c was significantly higher in the IR-TAC group compared to LCPT at 3 (5.5 vs. 4.9%, p = 0.01), 6 (5.6 vs. 4.9%, p = 0.01) and 12 months (5.8 vs. 5.1%, p = 0.07). ConclusionsSignificantly lower rates of rejection were observed in patients receiving LCPT. The once daily dosing may facilitate medication adherence and result in improved long-term outcomes.

Outcomes of malignant melanoma in kidney transplant recipients .

Kidney transplant recipients (KTRs) have an increased risk of skin cancer. We analyzed the outcomes of KTRs transplanted at our center between January 1, 1994, and December 31, 2015, who reported pretransplant melanoma or had post-transplant de novo melanoma. Of 6,522 kidney or kidney with pancreas transplant recipients, 37 had pretransplant melanoma. After adjustment of multiple variables, pretransplant melanoma was associated with overall increased risk of death (HR: 1.75, 95% CI 1.02 - 3.03, p=0.04) but not for death-censored graft failure (DCGF). A total of 46 patients developed post-transplant de novo melanoma. After adjustment of multiple variables, post-transplant de novo melanoma was associated with significant risk for death within the first year of the diagnosis of melanoma (HR: 4.40, 95% CI 2.21 - 8.74, p < 0.001), and DCGF after the first year (HR: 1.93, 95% CI 1.13 - 3.64, p=0.04). Similarly, among all pretransplant candidates (including those with history of melanoma) in Cox regression multivariate analysis, older age (HR: 1.32, 95% CI 0.31 - 1.14, p=0.04) and a history of pretransplant melanoma (HR: 9.27, 95% CI 2.81 - 30.53, p < 0.001) were significantly associated with the risk for development of post-transplant melanoma. Proper risk stratification and early diagnosis may improve patient and graft survival.

Pancreas allograft biopsies procedure in the management of pancreas transplant recipients.

Pancreas transplantation is an effective therapy for diabetic patients, which can significantly improve the survival rate and quality of life of diabetic patients. According to the international registration of pancreas transplantation center, the global total pancreas transplantation has reached more than 80,000 cases by 2017, including pure pancreas transplantation and simultaneous pancreas-kidney transplantation (SPK). With the development and application of a new type of immunosuppressant, with the gradual maturity of organ preservation technology and surgical technology, the pancreas transplantation has rapidly on a global scale. However, pancreas transplantation still has more problems than limit its development compared with other organ transplantation. For example, the early diagnosis and treatment of pancreatic rejection are of considerable significance to the prognosis of pancreas transplantation. Some surveillance methods of diagnosis have been used increasingly, among which the histopathological diagnosis is particularly important. The first Banff schema for the histological diagnosis of pancreas rejection has been published, which primarily dealt with the diagnosis of acute T-cell-mediated rejection (ACMR). In recent years, antibody-mediated rejection (AMR) has been more emphasized as the primary cause of graft failure. The Banff pancreas allograft rejection grading schema was updated in 2011 by a broad-based multidisciplinary panel, presenting comprehensive guidelines for the diagnosis of AMR.

Outcomes after simultaneous kidney‐pancreas versus pancreas after kidney transplantation in the current era

Simultaneous pancreas and kidney (SPK) and pancreas after kidney (PAK) transplant are both potential options for diabetic ESRD patients. Historically, PAK pancreas graft outcomes were felt to be inferior to SPK pancreas graft outcomes. Little is known about outcomes in the modern era of transplantation. We analyzed our SPK and PAK recipients transplanted between 01/2000 and 12/2016. There were a total of 635 pancreas and kidney transplant recipients during the study period, 611 SPK and 24 PAK. Twelve of the PAK patients received a living donor kidney. There were no significant differences between the two groups in kidney or pancreas graft rejection at 1year. Similarly, 1-year graft survival for both organs was not different. At last follow-up, uncensored and death-censored graft survival was not statistically different for kidney or pancreas grafts. In addition, in Cox regression analysis SPK and PAK were associated with similar graft survival. Although the majority of pancreas transplants are in the form of SPK, PAK is an acceptable alternative. Simultaneous pancreas and kidney avoids donor risks associated with live donation, so may be preferable in regions with short wait times, but PAK with a living donor kidney may be the best alternative in regions with long SPK wait times.