SOLITARY PANCREAS ALLOGRAFTS - THE ROLE OF PERCUTANEOUS BIOPSY AND STANDARDIZED HISTOLOGIC GRADING OF REJECTION

Objective: To determine the potential impact of ultrasound-guided perc utaneous pancreas allograft biopsy and standardized histologic grading on graft and patient survival in a solitary pancreas transplant progr am. Design: Retrospective case series survey. Setting: Tertiary care, university teaching hospital. Patients: Thirty-five recipients of soli tary pancreas transplants. Interventions: Percutaneous pancreas allogr aft biopsies were performed in solitary pancreas transplant recipients . Main Outcome Measures: Actuarial graft and patient survival, cause o f graft loss. Results: Initiation of ultrasound-guided percutaneous pa ncreas allograft biopsy with standardized histologic grading is associ ated with a 70% 1-year graft survival and 93% 1-year patient survival in solitary pancreas transplantation Acute rejection was responsible f or only 11% of cases of graft loss. The presence of endotheliitis, vas culitis, or confluent acinar necrosis is associated with decreased pan creas allograft survival, poor response to corticosteroid therapy, and shortened time interval to ultimate graft loss. Clinical criteria for acute rejection such as elevated serum amylase or lipase levels, 50% decrease in urinary amylase levels, unexplained fever, or hyperglycemi a are associated with a positive predictive value of only 72%. Conclus ion: Pancreas allograft biopsy and standardized histologic grading are associated with significantly improved 1-year graft and patient survi val in solitary pancreas transplantation.