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HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION
Cinthia B. Drachenberg, M.D.University of Maryland
School of Medicine
PANCREAS TRANSPLANTATION
Graft survival rates continue to improve Simultaneous pancreas-kidney 85% Pancreas after kidney 77% Pancreas transplant alone 73%
Patient survival at one year >94%
HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION
12 years since the first
percutaneous biopsies were
performed (Allen et al. Transplantation
1991;51: 1213).
1000 pancreas transplant bx at the
Univ. of Maryland since 1992
Experimental models of acute pancreas allograft rejection SEPTAL INFLAMMATION
VENOUS ENDOTHELIITIS AND INFLAMMATION OF DUCTS
ACINAR INFLAMMATION INFLAMMATION OF ARTERIAL
BRANCHESAllen et al: Am J Pathol 1991,138:303Schulak et al: Surgery 1995,98:330.Steineger et al: Am J Pathol 1986,124:253.Carpenter et al: Transplantation 1989,48:764.
GRADING ACUTE REJECTION
0 No inflammationI Minimal septal inflammationII Venous endotheliitisIII Acinar inflammationIV Arterial endotheliitis/
transmural arteritisV Parenchymal necrosis
(Drachenberg et al.: Transplantation 1997;63:1579-86)
PANCREAS TRANSPLANT NEEDLE BIOPSY
Minimum tissue amount adequate for diagnosis in a needle biopsy: Two lobules with associated septal tissue
(arteries,veins, ducts).
H&E stained sections x3 Masson’s trichrome stain Unstained slides
Comparison between the first 100 and the last 100 biopsies
First 100 Last 100Ac Rej Grade 0 15 29Ac Rej Grade I 9 8Ac Rej Grade II 12 8Ac Rej Grade III 44 28Ac Rej Grade IV 7 3Ac Rej Grade V 5 0
Total Acute RejTotal Acute Rej 68%68% 39%39%
ACUTE AND CHRONIC REJECTION OVER TIME IN A TYPICAL CASE OF GRAFT LOSS
012345
5 10 15 20 25 30
TIME IN MONTHS
RE
JEC
TIO
N
GR
AD
ES
Acute Rej
Chronic Rej
(Papadimitriou et al.: AJT May 2003)
PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
Chronic rejection Grade 0
Normal septa
PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
Chronic rejection Grade I
Fibrosis in <30% of core
Center of the lobules intact
PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
Chronic rejection Grade II
Fibrosis in 30-60% of core
Center of the lobules
shows fibrosis
PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
Chronic rejection Grade III
Extensive fibrosis in >60% of core
Minimal residual parenchyma
CHRONIC REJECTION GRADE IN RELATIONSHIP TO TIME ELAPSED POST-TX AND TIME OF REMAINING GRAFT FUNCTION
0
5
10
15
20
25
30
35
40
45
50
55
0 I II III
CHRONIC REJECTION GRADE
TIM
E IN
MO
NTH
S
TIME POST- TX
REMAINING TIME OFGRAFT FUNCTION
GRADO DE RECHAZO CRONICO EN RELACION AL TIEMPODESDE EL TRANSPLANTE Y EN RELACION AL TIEMPO
RESIDUAL DE FUNCION PANCREATICA
Comparison between the first 100 and the last 100 biopsies
First 100 Last 100
Ch Rej Grade I 3 14Ch Rej Grade II 1 5Ch Rej Grade III 0 4
Total Chronic RejTotal Chronic Rej 4%4% 23%23%
HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION In comparison to other solid organ transplants, less is
known. This pathology field continues to evolve together with the clinical and surgical advances in pancreas transplantation.
Has been a very important tool for the improvement of patient and graft outcomes, particularly in solitary pancreas transplantation.