Protocol Duodenal Graft Biopsies Aid Pancreas Graft Surveillance

Background Histological evaluation of the pancreas graft is usually done on demand resulting in significant delays. This analysis reports on endoscopic protocol duodenal graft biopsies at regular intervals to determine feasibility, safety and monitoring benefits. Methods Protocol duodenal graft biopsies in 27 18 consecutive pancreas transplants (10 simultaneous pancreas kidney [SPK], 17 pancreas after kidney [PAK]) with a follow-up of a minimum of 12 months were performed at days 14, 30, 90, 180, 360, 430. UPMC classification for intestinal rejection was used. C4d staining was performed when antibody mediated rejection was suspected. Results Overall patient and pancreas graft survival was 100% and 93% at a mean follow-up of 2.8 years. 167 endoscopic biopsy procedures were performed in 27 grafts without any complication. Biopsies revealed rejection in 3 (30%) SPK recipients and in 15 (82%) of PAK recipients as early as 14 days posttransplant. Two patients underwent PAK retransplantation diagnosed with acute rejection at day 180. All except 1 recipient being treated for rejection, showed histological improvement following antirejection treatment. Following transient treatment success, a total of 3 pancreas grafts were lost for immunological reason. One loss was immediate despite antirejection treatment, 1 secondary to nonresolving rejection at 7 months and the third due to recurrent rejection 15 months posttransplantation. Additionally, biopsies detected vascular (venous thrombosis) and overimmunosuppression (CMV infection) complications. Conclusions Protocol graft duodenal biopsies detect complications following whole organ pancreas transplantation, are useful in guiding therapy and carry potential for improving outcome. Disclosure statement: The authors have nothing to disclose. Corresponding author: Privatdozent Dr. med. Jens Gunther Brockmann, Director Pancreas & Intestinal Transplant Program, Section Head Kidney & Pancreas Transplantation, Department of Surgery and Organ Transplant Centre, King Faisal Specialist Hospital & Research Centre, P.O. Box 33554, Riyadh, 11211, MBC 37, Kingdom of Saudi Arabia JGB: Designed the research, wrote the paper, performed surgery and follow-up, and participated in data analysis. AB: Participated in research design, the writing of the paper, the performance of the research (endoscopies) and participated in data analysis. HAH: Participated in the writing of the paper, the performance of the research (histology) and participated in data analysis. HAM: Participated in the writing of the paper, the performance of the research (histology) and participated in data analysis. KAS: Participated in the writing of the paper, the performance of the research (histology) and participated in data analysis. MA: Participated in the performance of the research (HLA analysis, follow-up). DCB: Participated in research design. TA: Participated in the writing of the paper, the performance of the research (follow- up), and participated in data analysis. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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