ISOLATED PANCREAS REJECTION IN COMBINED KIDNEY-PANCREAS TRANSPLANTATION

The clinical success of pancreas transplantation is limited by the dif ficulty in diagnosing rejection, In simultaneous pancreas kidney (SPK) transplantation, the diagnosis of pancreatic rejection is particularl y difficult in the absence of clinical evidence of kidney rejection, M oreover, patients receiving only pancreas grafts will not have a conco mitantly grafted kidney to serve as a ''sentinel'' for rejection, Perc utaneous pancreas graft biopsy has been reported in a few small series but has not been adopted for broad clinical use, We describe the eval uation of 69 consecutive episodes of suspected isolated pancreas allog raft rejection by percutaneous pancreas allograft biopsy, These reject ion episodes occurred in 41 patients with bladder-drained pancreas tra nsplants (25 SPK, 14 pancreas after kidney transplants [PAK], and two pancreas transplant alone [PTA]). The indications for percutaneous pan creas biopsy were a twofold or greater increase in serum amylase or li pase, or a sustained 40% to 50% drop in urine amylase in the setting o f no evidence of renal allograft dysfunction in SPK transplants, Biops ies were performed with color-flow Doppler ultrasound localization usi ng an 18-gauge automated biopsy needle, Pancreatic tissue adequate for histologic evaluation was obtained in 61 of 69 cases (88%), There wer e two cases of intraabdominal bleeding, one of which required surgical intervention; the other resolved spontaneously, Histologic assessment of the biopsies demonstrated varying degrees of acute cellular reject ion in 48 of 61 specimens (79%), Twelve specimens (20%) were free of h istologic evidence of rejection, and one specimen (2%) showed acute pa ncreatitis, At the time of suspected rejection mean serum amylase and lipase values were increased 3.6 and 8.3-fold, respectively, and urine amylase was decreased by a mean of 45%. We conclude that the commonly used markers for pancreas allograft rejection are only about 80% spec ific for acute rejection, Percutaneous pancreas allograft biopsy is sa fe and allows the avoidance of unnecessary antirejection therapy with its attendant side effects and costs.