Renal allograft rejection with normal renal function in simultaneous kidney/pancreas recipients - Does dissynchronous rejection really exist?

Background. Between July 1, 1994 and December 1, 1998, 147 simultaneous kid ney/pancreas transplantations were performed at our center. Of 95 patients who experienced at least one acute renal allograft rejection episode after transplantation, 7 (7.4%) developed rejection in the presence of stable and normal or near-normal renal function. Methods. The indication for renal allograft biopsy was a rising serum lipas e, i.e., suspected pancreatic rejection. All seven patients were treated wi th steroids and augmentation of the tacrolimus dose, with a fall in the ser um lipase and no change in the serum creatinine. Results. The serum creatinine levels just before, at the time of, 1 week af ter the biopsy, and at most recent follow-up were 1.4+/-0.4, 1.3+/-0.3, 1.2 +/-0.2, and 1.2+/-0.2 mg/dl, The serum lipase levels just before, at the ti me of, 1 week after the biopsy, and at most recent follow-up were 1022+/-11 57 mg/dl, 874+/-996 mg/dl, 243+/-260 mg/dl, and 94+/-75 mg/dl, The tacrolim us dosages and levels at the time of the biopsy and 1 week later were 14.9/-5.0 mg/day and 15.0+/-4.0 ng/ml, and 16.4+/-6.3 mg/ day and 15.1+/-6.8 ng /ml. Conclusions. These findings suggest that, in patients undergoing simultaneo us kidney/pancreas transplantation, the entity of dissynchronous pancreatic allograft rejection without renal allograft rejection may not really exist . These data also make an additional fundamental point that acute rejection may occur in patients with normal and stable renal function.