CYSTOSCOPIC BIOPSIES IN PANCREATICODUODENAL TRANSPLANTATION - ARE DUODENAL BIOPSIES INDICATIVE OF PANCREAS DYSFUNCTION

Tissue diagnosis of pancreas graft dysfunction is desirable, Bladder-d rained pancreaticoduodenal transplants allow tissue diagnosis by cysto scopic biopsy procedures of the pancreas and duodenum, To assess the d iagnostic utility of duodenal biopsies, we reviewed all cystoscopicall y obtained pancreas and duodenal biopsy tissues at our institution (Ju ly 1, 1989 through September 30, 1993), Adequate tissue for histologic examination was obtained from 75 biopsies in 58 recipients. Indicatio ns for cystoscopic biopsies were relative hypoamylasuria in 85%, hemat uria in 6%, hyperamylasemia in 3%, and other causes in 6%. Duodenal sp ecimens were available from 52 biopsies (25 with, and 27 without, conc urrent pancreas biopsies). Of the 27 duodenal biopsies alone, 3 were d iagnostic of rejection, 15 had features consistent with rejection, 6 w ere normal, 1 showed fibrosis, 1 showed necrosis, and 1 was ulcerated. Thus, two-thirds of the duodenal biopsies alone yielded clinically re levant information resulting in antirejection treatment. In 25 of the duodenal biopsies, pancreas tissue was also available (11 simultaneous pancreas-kidney, 9 pancreas transplant alone, and 5 pancreas after ki dney recipients). Findings in both organs completely agreed in 9 (36%) of the biopsies. In 7 (28%), rejection was suggested or diagnosed in both organs, although the organs were discrepant with regard to the pr esence of vascular rejection (6 pancreas, 1 duodenum). In 2 (11%), min or nonrejection discrepant findings were present. Therefore, in 18 of 25 (72%) pancreas-duodenal biopsies, treatment would not have been dif ferent if only one graft had been biopsied. But in the other 7 (28%), treatment would have been different if only the organ with negative fi ndings had been biopsied. In 6 cases (4 duodenal, 2 pancreas), rejecti on was seen in one organ but not the other. In 1 case, cytomegalovirus (CMV) inclusions were present in the duodenum, but the pancreas was n ormal. We conclude that (1) the duodenum and pancreas can reject indep endently of each other, and a negative biopsy does not preclude reject ion of the other organ; (2) duodenal biopsies determined therapeutic d ecisions one-fifth of the time when both tissues were available for ex amination, and two-thirds of the time when only duodenal tissue was av ailable; and (3) since cystoscopy allows easy access to the duodenum, both the pancreas and duodenum should be biopsied whenever possible; t issue samples of one organ alone are sufficient only with positive fin dings.