THE INCIDENCE OF INTERSTITIAL AND VASCULAR KIDNEY REJECTION AFTER PANCREAS-KIDNEY TRANSPLANTATION

Several groups have reported that recipients of a simultaneous pancrea s-kidney transplantation suffer from more kidney rejection episodes th an do recipients of a kidney transplantation (1-6). However, it is not known whether this is interstitial rejection, vascular rejection, or both. In this study, the renal biopsies and transplantectomies of 45 p ancreas-kidney and 48 kidney transplant recipients were evaluated for the presence of interstitial and vascular rejection. Furthermore, the influence of OKT3 induction therapy on rejection after pancreas-kidney transplantation was studied. Of the 45 pancreas-kidney recipients, 4 patients did not suffer from rejection during follow-up, 28 suffered o nly from interstitial rejection, and 13 suffered from vascular (with o r without interstitial) rejection, whereas 12, 19, and 14 of the 48 ki dney transplant patients had no rejection, interstitial rejection, or vascular (with or without interstitial) rejection, respectively. Three patients with a kidney transplant were treated for rejection although no biopsy was taken, In the pancreas-kidney group, 38 of the total of 149 biopsies and transplantectomies taken contained no rejection, 92 had interstitial rejection, and 19 had vascular rejection. In the kidn ey group, these values were 13, 41, and 25, respectively, of 79 biopsi es and transplantectomies taken (P = 0.002). Five-year renal graft sur vival was 79% in the kidney group and 60% in the pancreas-kidney group . Renal graft survival rates differed significantly (P = 0.02). Renal graft survival and occurrence of rejection did not reach significance between pancreas-kidney recipients treated with OKT3 induction therapy and pancreas-kidney recipients receiving conventional triple therapy. It was concluded that patients with a pancreas-kidney transplantation in this study suffered from more interstitial rejection, that is the more benign histologic type of rejection, than did recipients of a kid ney transplantation, Furthermore, it was concluded that OKT3 induction did not result in less rejection or a better graft survival in the pa ncreas-kidney group.