PREFERENTIAL REJECTION OF THE KIDNEY IN A SIMULTANEOUS KIDNEY-PANCREAS TRANSPLANT

A case of selective kidney allogratt rejection with stable pancreas fu nction in a patient who received simultaneous kidney-pancreas allograf t from the same donor is reported. Pancreas function was shown to be n ormal within the first month posttransplant by both a glucose toleranc e test (despite a high corticosteroid dose) and stable urinary amylase values during biopsy-proven acute renal allogratt rejection. This pat ient subsequently rejected his kidney allograft as documented by histo pathologic evidence of severe chronic vascular rejection and acute tub ulointerstitial rejection, yet his pancreas function remained intact. He subsequently received a six-antigen-matched kidney, continues to ha ve normal fasting glucose and normal glucose tolerance by oral glucose tolerance test, and is without evidence of glucosuria. He has never h ad a clinical rejection of his pancreas, as evidenced by either a decl ine in urinary amylase or hyperglycemia, and has not required insulin except in the perioperative period of his second kidney transplant, at which time he was receiving high doses of both corticosteroids and cy closporin. It is suggested that preferential rejection and subsequent loss of the kidney, although infrequent, do occur in combined renal-pa ncreas allografts and that maintenance of immunosuppression is justifi ed until retransplant of kidney is available.