Skip to main content
SpringerLink
Log in

Immunobiology, Diagnosis, and Treatment of Pancreas Graft Rejection

  • Chapter
Transplantation of the Pancreas

Abstract

The immunologic basis of graft rejection was established by Medawar1,2 in the 1940s and 1950s. Since then, remarkable progress has been made in understanding the complexity of the rejection process and developing strategies to abrogate its occurrence. Over the last 20 years, it has become apparent that the immunobiology of pancreas allograft rejection is not different, by and large, from that of other types of solidorgan transplants. Some evidence, however, suggests that the mechanisms of rejection might be slightly different for exocrine vs endocrine pancreatic tissue.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Medawar PB. Behaviour and fate of skin autografts and skin homografts in rabbits. J Anat 1944; 78: 176–199.

    PubMed  CAS  Google Scholar 

  2. Medawar PB. A second study of the behaviour and fate of skin homografts in rabbits. J Anat 1945; 79: 157–176.

    Google Scholar 

  3. Dallman MJ. Immunobiology of graft rejection. In: Ginns LC, Cosimi AB, Morris PJ, eds. Transplantation. Philadelphia: Blackwell Science; 1988: 23–4 2.

    Google Scholar 

  4. Troppmann C, Gillingham KJ, Benedetti E, et al. Delayed graft function, acute rejection, and outcome after cadaver renal transplantation-a multivariate analysis. Transplantation 1995; 59: 962–968.

    Article  PubMed  CAS  Google Scholar 

  5. Troppmann C, Benedetti E, Gruessner AC, et al. Delayed endocrine pancreas graft function after simultaneous pancreas-kidney transplantation: Incidence, risk factors, and impact on long-term outcome. Transplantation 1996; 61: 1323–1330.

    Article  PubMed  CAS  Google Scholar 

  6. Sabatine MS, Auchinschloss H. In: Solez K, Racusen LC, Billingham ME, eds. Solid Organ Transplant Rejection. New York: Marcel Dekker; 1996; 1–28.

    Google Scholar 

  7. Daar AS, Fuggle SV, Fabre JW, et al. The detailed distribution of HLA-A, B, C antigens in normal human organs. Transplantation 1984; 38: 287–292.

    Article  PubMed  CAS  Google Scholar 

  8. Daar AS, Fuggle SV, Fabre JW, et al. The detailed distribution of MHC class II antigens in normal human organs. Transplantation 1984; 38: 293–298.

    Article  PubMed  CAS  Google Scholar 

  9. Steiniger B, Klempnauer J, Wonigkeit K. Altered distribution of class I and class II MHC antigens during acute pancreas allograft rejection in the rat. Transplantation 1985; 40: 234–239.

    Article  PubMed  CAS  Google Scholar 

  10. Faustman D, Hauptfeld V, Lacy P, et al. Prolongation of murine islet allograft survival by pretreatment of islets with antibody directed to Ia determinants. Proc Natl Acad Sci USA 1981; 78: 5156–5159.

    Article  PubMed  CAS  Google Scholar 

  11. Gores PF, Sutherland DER, Platt JL, et al. Depletion of donor Ia+ cells before transplantation does not prolong islet allograft survival. J Immunol 1986; 137: 1482–1485.

    PubMed  CAS  Google Scholar 

  12. Bretzel RG, Flesch BK, Brennestuhl G, et al. Rat pancreatic islet pretreatment with anti-MHC class II monoclonal antibodies and culture: In vitro MLC test response does not predict islet allograft survival. Acta Diabetol 1993; 30: 49–56.

    Article  PubMed  CAS  Google Scholar 

  13. McKenna RM, Takemoto SK, Terasaki PI. Anti-HLA antibodies after solid organ transplantation. Transplantation 2000; 69: 319–326.

    Article  PubMed  CAS  Google Scholar 

  14. Pelletier RP, Hennessy PK, Adams PW, et al. Clinical significance of MHC-reactive alloantibodies that develop after kidney or kidney-pancreas transplantation. Am J Transplant 2002; 2: 134–141.

    Article  PubMed  CAS  Google Scholar 

  15. Snell GD. The homograft reaction. Annu Rev Microbiol 1957; 1: 439–458.

    Article  Google Scholar 

  16. Reis e Sousa C, Stahl PD, Austyn JM. Phagocytosis of antigens by Langerhans cells in vitro. J Exp Med 1993; 178: 509519.

    Google Scholar 

  17. Steinman RM, Gutchinov B, Witmer MD, et al. Dendritic cells are the peripheral stimulators of the primary mixed leucocyte reaction in mice. J Exp Med 1983; 157: 613–627.

    Article  PubMed  CAS  Google Scholar 

  18. Billingham RE. The passenger cell concept in transplantation. Cell Immunol 1971; 1: 1–12.

    Article  Google Scholar 

  19. Lechler RI, Batchelor JR. Restoration of immunogenicity to passenger cell-depleted kidney allografts by the addition of donor strain dendritic cells. J Exp Med 1982; 155: 31–41.

    Article  PubMed  CAS  Google Scholar 

  20. Pober JS, Cotran RS. Immunologic interactions of T lymphocytes with vascular endothelium. Adv Immunol 1991; 50: 26 1302.

    Google Scholar 

  21. Turka L. Normal immune responses. In: Norman D, Turka LA, eds. Primer on Transplantation. 2nd ed. American Society of Transplantation, Mt. Laurel, NJ; 2001: 3–16.

    Google Scholar 

  22. Larsen CP, Elwood ET, Alexander DZ, et al. Long-term acceptance of skin and cardiac allografts after blocking CD40 and CD28 pathways. Nature 1996; 381: 434–438.

    Article  PubMed  CAS  Google Scholar 

  23. Kirk AD, Burkly LC, Batty DS, et al. Treatment with humanized monoclonal antibody against CD154 prevents acute renal al- lograft rejection in nonhuman primates. Nat Med 1999; 5: 686–693.

    Article  PubMed  CAS  Google Scholar 

  24. LeMoine A, Goldman M, Abramowicz D. Multiple pathways to allograft reaction. Transplantation 2002; 73: 1373–1381.

    Article  Google Scholar 

  25. Strom TB, Roy-Chadhury P, Manfro R, et al. The Thl/Th2 paradigm and the allograft response. Curr Opin Immunol 1996; 8: 688–693.

    Article  PubMed  CAS  Google Scholar 

  26. Nickerson P, Steurer W, Steiger J, et al. Cytokines and the Thl/Th2 paradigm in transplantation. Curr Opin Immunol 1994; 6: 757–764.

    Article  PubMed  CAS  Google Scholar 

  27. Austrup F, Vestweber D, Borges E, et al. P- and E-selectin mediate recruitment of T-helper-1, but not T-helper-2 cells into inflamed tissues. Nature 1997; 385: 81–86.

    Article  PubMed  CAS  Google Scholar 

  28. Krensky AM. Immune response to allografts. In: Norman DJ, Turka LA, eds. Primer on Transplantation. 2nd ed. American Society of Transplantation, Mt. Laurel, NJ: 2001; 16–25.

    Google Scholar 

  29. Ghasemian SR, Light JA, Sasaki TA, et al. Hyperacute rejection from antibody against class II HLA antigens. Clin Transplant 1998; 12: 569–571.

    PubMed  CAS  Google Scholar 

  30. Boonstra JG, Weyer PC, Laterveer JC, et al. Apoptosis of acinar cells in pancreas allograft rejection. Transplantation 1997; 64: 1211–1213.

    Article  PubMed  CAS  Google Scholar 

  31. Nakleh RE, Gruessner RWG. Ischemia due to vascular rejection causes islet loss after pancreas transplantation. Transplant Proc 1998; 30 (2): 539.

    Article  Google Scholar 

  32. Stratta RJ, Sollinger HW, D’Alessandro AM, et al. OKT3 rescue therapy in pancreas-allograft rejection. Diabetes 1989; 38: 74–78.

    PubMed  Google Scholar 

  33. Sutherland DER, Dunn DL, Goetz FC, et al. A ten-year experience with 290 pancreas transplants at a single institution. Ann Surg 1989; 210: 274–285.

    Article  PubMed  CAS  Google Scholar 

  34. Gruesser RWG, Sutherland DER. Clinical diagnosis in pancreas allograft rejection. In: Solez K, Racusen LC, Billingham ME, eds. Solid Organ Transplant Rejection: Mechanisms, Pathology and Diagnosis. New York: Marcel Dekker; 1996: 455–499.

    Google Scholar 

  35. Stratta RJ, Taylor RJ, Grune MT, et al. Experience with protocol biopsies after solitary pancreas transplantation. Transplantation 1995; 60: 1431–1437.

    Article  PubMed  CAS  Google Scholar 

  36. Gliedman ML, Gold M, Whittaker J, et al. Pancreatic duct to ureter anastomosis in pancreatic transplantation. Am J Surg 1973; 125: 245–252.

    Article  PubMed  CAS  Google Scholar 

  37. Sollinger HW, D’Alessandro AM, Stratta RJ, et al. Combined kidney-pancreas transplantation with pancreaticocystostomy. Transplant Proc 1989; 21: 2837–2838.

    PubMed  CAS  Google Scholar 

  38. Gruessner RWG, Nakhleh R, Tzardis P, et al. Differences in rejection grading after simultaneous pancreas and kidney transplantation in pigs. Transplantation 1994; 57: 1021–1028.

    PubMed  CAS  Google Scholar 

  39. Prieto M, Sutherland DER, Fernandez-Cruz L, et al. Urinary amylase monitoring for early diagnosis of pancreas allograft rejection in dogs. J Surg Res 1986; 40: 597–604.

    Article  PubMed  CAS  Google Scholar 

  40. Prieto M, Sutherland DER, Fernandez-Cruz L, et al. Experimental and clinical experience with urine amylase monitoring for early diagnosis of rejection in pancreas transplantation. Transplantation 1987; 43: 73–79.

    Article  PubMed  CAS  Google Scholar 

  41. Schulak JA, Drevyanko TF. Experimental pancreas allograft rejection: Correlation between histologic and functional rejection and the efficacy of antirejection therapy. Surgery 1985; 98: 330336.

    Google Scholar 

  42. Nankivell BJ, Allen RDM, Bell B, et al. Factors affecting measurement of urinary amylase after bladder-drained pancreas transplantation. Clin Transplant 1991; 5: 392–397.

    Google Scholar 

  43. Moukarzel M, Benoit G, Charpentier B, et al. Is urinary amylase a reliable index for monitoring whole pancreas endocrine graft function? Transplant Proc 1992; 24: 925–926.

    PubMed  CAS  Google Scholar 

  44. Lievens MM. Potential pitfalls in the determination of amylase activity in the urine of pancreas-transplanted patients with bladder drainage. Transplantation 1990; 50: 526–527.

    Article  PubMed  CAS  Google Scholar 

  45. Henry ML, Osei K, O’Dorisio TM, et al. Concomitant reduction in urinary amylase and acute first-phase insulin release predict pancreatic allograft transplant rejection in type I diabetic recipients. Clin Transplant 1991; 5: 112–120.

    Google Scholar 

  46. Munn SR, Engen DE, Barr D, et al. Differential diagnosis of hypoamylasuria in pancreas allograft recipients with urinary exocrine drainage. Transplantation 1990; 49: 359–362.

    Article  PubMed  CAS  Google Scholar 

  47. Benedetti E, Najarian JS, Sutherland DER, et al. Correlation between cystoscopic biopsy results and hypoamylasuria in bladder-drained pancreas transplants. Surgery 1995; 118: 864–872.

    Article  PubMed  CAS  Google Scholar 

  48. Nghiem DD, Cottington EM, Corry RJ. Physiologic studies of urinary drained pancreaticoduodenal grafts in humans. J Surg Res 1990; 48: 72–77.

    Article  PubMed  CAS  Google Scholar 

  49. Müller TF, Trosch F, Ebel H, et al. Pancreas-specific protein (PASP), serum amyloid A (SAA), and neopterin (NEOP) in the diagnosis of rejection after simultaneous pancreas and kidney transplantation. Transplant Int 1997; 10: 185–191.

    Article  Google Scholar 

  50. Soon-Shiong P, Zheng TL, Merideth N, et al. Elevation in urinary prostaglandin (PGE2) as an early marker of pancreas allograft rejection. Transplant Proc 1989; 21: 2771–2773.

    PubMed  CAS  Google Scholar 

  51. Rubenstein HH, Clark JL, Melani F, et al. Secretion of proinsulin C-Peptide by pancreatic B cells and its circulation in blood. Nature 1969; 224: 697–699.

    Article  CAS  Google Scholar 

  52. Chance RE, Ellis RM, Bromer WW. Porcine proinsulin: Characterization and amino acid sequence. Science 1968; 161: 165–167.

    Article  PubMed  CAS  Google Scholar 

  53. Esmatjes E, Fernandez Cruz L, Ricart MJ, et al. Urinary C-peptide excretion in pancreas transplantation with urinary drainage Transplant Proc 1990; 22: 1598–1599.

    CAS  Google Scholar 

  54. Gill IS, Stratta RI, Taylor MT, et al. Correlation of serologic and urinary tests with allograft biopsy in the diagnosis of pancreas rejection. Transplant Proc 1997; 29: 673.

    Article  PubMed  CAS  Google Scholar 

  55. Tydén G, Gunnarsson R, Östman J, et al. Laboratory findings during rejection of segmental pancreatic allografts. Transplant Proc 1984; 16: 715–717.

    Google Scholar 

  56. Ploeg RJ, D’Alessandro AM, Groshek M, et al. Efficacy of human anodal trypsinogen for detection of rejection in clinical pancreas transplantation. Transplant Proc 1994; 26: 531–533.

    PubMed  CAS  Google Scholar 

  57. Cheng SS, Munn SR. Posttransplant hyperamylasemia is associated with decreased patient and graft survival in pancreas allograft recipients. Transplant Proc 1994; 26: 428–429.

    PubMed  CAS  Google Scholar 

  58. Sugitani A, Egidi F, Gritsch HA, et al. Serum lipase as a marker for pancreatic allograft rejection. Clin Transplant 1998; 12: 224227.

    Google Scholar 

  59. Padamitriou JC, Drachenberg CB, Wiland A, et al. Histologic grading of acute allograft rejection in pancreas needle biopsy. Transplantation 1998; 66: 1741–1745.

    Article  Google Scholar 

  60. Eckfeldt JH, Levitt MD. Diagnostic enzymes for pancreatic disease. Clin Lab Med 1989; 9: 731–743.

    PubMed  CAS  Google Scholar 

  61. Borgström A, Marks WH, Dafoe DC, et al. Immunoreactive anionic and cationic trypsins in serum after experimental porcine pancreatic transplantation. Surgery 1986; 100: 841–848.

    PubMed  Google Scholar 

  62. Marks WH, Borgström A, Sollinger H, et al. Serum immunoreactive anodal trypsinogen and urinary amylase as biochemical markers for rejection of clinical whole-organ pancreas alImmunobiology, Diagnosis, and Treatment of Pancreas Graft Rejection 375 lografts having exocrine drainage into the urinary bladder. Transplantation 1990; 49: 112–115.

    Google Scholar 

  63. Perkal M, Marks C, Lorber MI, et al. A three-year experience with serum anodal trypsinogen as a biochemical marker for rejection in pancreatic allografts. False positives, tissue biopsy, comparison with other markers, and diagnostic strategies. Transplantation 1992; 53: 415–419.

    Article  PubMed  CAS  Google Scholar 

  64. Douzdjian V, Cooper JL, Abecassis MM, et al. Markers for pancreatic allograft rejection: Comparison of serum anodal trypsinogen, serum amylase, serum creatinine and urinary amylase. Clin Transplant 1994; 8: 79–82.

    PubMed  CAS  Google Scholar 

  65. Lieberman JM, Marks WH, Stuart FP, et al. Co-monitoring serum anodal trypsinogen, serum amylase, and serum creatinine accurately differentiates rejection from other causes of allograft dysfunction after simultaneous pancreas-kidney transplantation. Transplant Proc 1997; 29: 676–677.

    Article  PubMed  CAS  Google Scholar 

  66. Matsuda K, Ogawa M, Shibata T, et al. Postoperative elevation of serum pancreatic secretory trypsin inhibitor. Am J Gastroenterol 1985; 80: 694–698.

    PubMed  CAS  Google Scholar 

  67. Kitahara T, Takatsuka Y, Fujimoto K, et al. Radioimmunoassay for human pancreatic secretory trypsin inhibitor: Measurement of serum pancreatic secretory trypsin inhibitor in normal subjects and subjects with pancreatic diseases. Clin Chim Acta 1980; 103: 135–143.

    Article  PubMed  CAS  Google Scholar 

  68. Suzuki Y, Kuroda T, Kawamura T, et al. Pancreatic secretory trypsin inhibitor as a marker for early detection of rejection in canine pancreas allotransplantation. Transplant Proc 1989; 21: 2793–2794.

    PubMed  CAS  Google Scholar 

  69. Kuroda Y, Suzuki Y, Kawamura T, et al. Pancreatic secretory trypsin inhibitor as a marker for early detection of rejection in canine pancreas allotransplantation. Transplantation 1988; 46: 493–495.

    Article  PubMed  CAS  Google Scholar 

  70. Suzuki Y, Kuroda Y, Sollinger HW, et al. Plasma pancreatic secretory trypsin inhibitor as a marker of pancreas graft rejection after combined pancreas-kidney transplantation. Transplantation 1991; 52: 504–507.

    Article  PubMed  CAS  Google Scholar 

  71. Suzuki Y, Kuroda Y, Sollinger HW, et al. Plasma phospholipase A2 and pancreatic secretory trypsin inhibitor as markers for pancreas graft rejection. Transplant Proc 1994; 26: 538–540.

    PubMed  CAS  Google Scholar 

  72. Fernstad R, Skoldefors H, Pousette A, et al. A novel assay for pancreatic cellular damage: III. Use of a pancreas-specific protein as a marker of pancreatic graft dysfunction in humans. Pancreas 1989; 4: 44–52.

    Article  PubMed  CAS  Google Scholar 

  73. Greene LJ, Pubols MH, Bartell DC. Human pancreatic secretory trypsin inhibitor. Meth Enzymol 1976; 359: 813–825.

    Article  Google Scholar 

  74. Fernstad R, Tydén G, Brattström C, et al. Rejection of pancreas grafts-pancreas-specific protein: New serum marker for graft rejection in pancreas-transplant recipients. Diabetes 1989; 38: 55–56.

    PubMed  Google Scholar 

  75. Nyberg G, Olausson M, Norden G, et al. Pancreas specific protein (PASP) monitoring in pancreas transplantation. Transplant Proc 1991; 23: 1604–1605.

    PubMed  CAS  Google Scholar 

  76. Minakawa R, Brattström C, Tydén G, et al. Serum levels of pancreatic amylase and pancreas-specific protein as markers of pancreatic graft rejection episodes. Transplant Proc 1995; 27: 1329–1330.

    PubMed  CAS  Google Scholar 

  77. van der Pijl JW, Boonstra JG, Barthellemy S, et al. Pancreatitis-associated protein: A putative marker for pancreas graft rejection. Transplantation 1997; 63: 995–1003.

    Article  PubMed  CAS  Google Scholar 

  78. Keim V, Iovanna JL, Orelle B, et al. A novel exocrine protein associated with pancreas transplantation in humans. Gastroenterology 1992; 103: 248–254.

    PubMed  CAS  Google Scholar 

  79. Keim V, lovanna JL, Dagorn JC. The acute phase reaction of the exocrine pancreas: Gene expression and synthesis of pancreatitis-associated protein. Digestion 1994; 55: 65–72.

    Article  PubMed  CAS  Google Scholar 

  80. Iovanna JL, Keim V, Nordback I, et al. Serum levels of pancreatitis-associated protein as indictors of the course of acute pancreatitis. Gastroenterology 1994; 106: 728–734.

    PubMed  CAS  Google Scholar 

  81. Marks WH, Borgström A, Sollinger H, et al. Serum immunoreactive anodal trypsinogen and urinary amylase as biochemical markers for rejection of clinical whole-organ pancreas allograft having exocrine drainage into the urinary bladder. Transplantation 1990; 49: 112–115.

    Article  PubMed  CAS  Google Scholar 

  82. Georgi BA, Dempsey RA, Corry RJ. Interleukin-2 assay in serum and urine as a means of monitoring pancreas allograft rejection. Transplant Proc 1989; 21: 2784–2785.

    PubMed  CAS  Google Scholar 

  83. Perkins JD, Munn SR, Barr D, et al. Evidence that the soluble interleukin 2 receptor level may determine the optimal time for cystoscopically directed biopsy in pancreaticoduodenal allograft recipients. Transplantation 1990; 49: 363–366.

    Article  PubMed  CAS  Google Scholar 

  84. Abendroth D, Capalbo M, Illner WD, et al. Critical analysis of rejection markers sIL-2R, urinary amylase, and lipase in whole-organ pancreas transplantation with exocrine bladder drainage. Transplant Proc 1992; 24: 786–787.

    PubMed  CAS  Google Scholar 

  85. Grewal HP, Kotb M, Salem A, et al. Elevated tumor necrosis factor levels are predictive for pancreas allograft transplant rejection. Transplant Proc 1993; 25: 132–135.

    PubMed  CAS  Google Scholar 

  86. Abendroth D, Storck M, Techt B, et al. Analysis of the rejection markers tumor necrosis factor, ICAM-1, neopterin, interleukin-10, and soluble HLA in simultaneous pancreas and kidney transplantation with bladder drainage. Transplant Proc 1995; 27: 3114–3115.

    PubMed  CAS  Google Scholar 

  87. Kandaswamy R, Gruessner A, Hering B, et al. IFN-y cytokine gene polymorphism (CGP) increases risk of rejection in pancreas transplant alone (PTA) recipients. Acta Chir Austriaca 2001; 33: 5–6.

    Article  Google Scholar 

  88. Pelletier R, Pravica V, Perrey C, et al. Evidence for a genetic predisposition towards acute rejection after kidney and simultaneous kidney-pancreas transplantation. Transplantation 2000; 70: 674–680.

    Article  PubMed  CAS  Google Scholar 

  89. Linder R, Sziegoleit A, Brattström C, et al. Pancreatic elastase 1 after pancreatic transplantation. Pancreas 1991; 6: 31–36.

    Article  PubMed  CAS  Google Scholar 

  90. Linder R, Sziegoleit A, Peters B, et al. Serum pancreatic elastase 1 as a marker of pancreatic graft damage. Transplant Proc 90; 22: 1595.

    Google Scholar 

  91. Brattström C, Tydén G, Reinholt FP, et al. Markers for pancreas-graft rejection in humans. Diabetes 1989; 38: 57–62.

    PubMed  Google Scholar 

  92. Königsrainer A, Tilg H, Reibnegger G, et al. Pancreatic juice neopterin excretion-a reliable marker of pancreas allograft rejection. Transplant Proc 1992; 24: 907–908.

    PubMed  Google Scholar 

  93. Funakoshi A, Yamada Y, Ito T, et al. Clinical usefulness of serum phospholipase A2 determination in patients with pancreatic diseases. Pancreas 1991; 6: 588–594.

    Article  PubMed  CAS  Google Scholar 

  94. Hashimoto T, Izumi R, Konishi K, et al. Experimental study on the relationship between prostaglandin production and acute pancreatic rejection. Transplant Proc 1989; 21: 505–506.

    PubMed  CAS  Google Scholar 

  95. Johnson BF, Thomas G, Wiley KN, et al. Thromboxane and prostacyclin synthesis in experimental pancreas transplantation: Changes in parenchymal and vascular prostanoids. Transplantation 1993; 56: 1447–1453.

    Article  PubMed  CAS  Google Scholar 

  96. Tanaka S, Kamike W, Ito T, et al. Generation of nitric oxide as a rejection marker in rat pancreas transplantation. Transplantation 1995; 60: 713–717.

    Article  PubMed  CAS  Google Scholar 

  97. Casanova D, Martino E, Amado JA, et al. High levels of nitric oxide metabolites can be correlated with rejection episodes in experimental pancreas transplantation. Transplant Proc 2002; 34: 213–214.

    Article  PubMed  CAS  Google Scholar 

  98. Elmer DS, Hathaway DK, Shokouh-Amiri H, et al. The relationship of glucose disappearance rate (KG) to acute pancreas allograft rejection. Transplantation 1994; 57: 1400–1405.

    Article  PubMed  CAS  Google Scholar 

  99. Elmer DS, Hathaway DK, Abdulkarim AB, et al. Use of glucose disappearance rates (KG) to monitor endocrine function of pancreas allografts. Clin Transplant 1998; 12: 56–64.

    PubMed  CAS  Google Scholar 

  100. Elmer DS, Hughes DK, Hathaway MH, et al. Use of glucose disappearance rates to monitor /3-cell function of pancreas allografts. Transplant Proc 1995; 27: 2985–2986.

    PubMed  CAS  Google Scholar 

  101. Henry ML, Osei K, O’Dorisio TM, et al. Concomitant reduction in urinary amylase and acute first-phase insulin release predict pancreatic allograft transplant rejection in type I diabetic recipients. Clin Transplant 1991; 5: 112–120.

    Google Scholar 

  102. Henry ML, Davies EA, Elkhammas EA, et al. Pancreatic allograft function as assessed by IMX first-phase insulin assays. Transplant Proc 1994; 26: 537.

    PubMed  CAS  Google Scholar 

  103. Ganda OP, Srikanta S, Brink SJ, et al. Differential sensitivity to ß cell secretagogues in “early,” type I diabetes mellitus. Diabetes 1984; 33: 516–521.

    Article  PubMed  CAS  Google Scholar 

  104. Gruessner RWG, Dunn DL, Tzardis PJ, et al. Simultaneous pancreas and kidney transplants versus single kidney transplants and previous kidney transplants in uremic patients and single pancreas transplants in nonuremic diabetic patients: Comparison of rejection, morbidity, and long-term outcome. Transplant Proc 1990; 22: 622–623.

    PubMed  CAS  Google Scholar 

  105. Sutherland DER, Casanova D, Sibley RK. Monitoring and diagnosis of rejection: Role of pancreas graft biopsies in the diagnosis and treatment of rejection after pancreas transplantation. Transplant Proc 1987; 19: 2329–2331.

    PubMed  CAS  Google Scholar 

  106. Kuo PC, Johnson LB, Schweitzer EJ, et al. Solitary pancreas allografts. The role of percutaneous biopsy and standardized histologic grading of rejection. Arch Surg 1997; 132: 52–57.

    Article  PubMed  CAS  Google Scholar 

  107. Perkins JD, Munn SR, Marsh CL, et al. Safety and efficacy of cystoscopically directed biopsies in pancreas transplantation. Transplant Proc 1990; 22: 665–666.

    PubMed  CAS  Google Scholar 

  108. Jones JW, Nakhleh RE, Casanova D, et al. Cystoscopic trans-duodenal pancreas transplant biopsy: A new needle. Transplant Proc 1994; 26: 527–528.

    PubMed  CAS  Google Scholar 

  109. Lowell JA, Bynon JS, Nelson N, et al. Improved technique for transduodenal pancreas transplant biopsy. Transplantation 1994; 57: 752–753.

    Article  PubMed  CAS  Google Scholar 

  110. Nakhleh RE, Sutherland DER, Tzardis P, et al. Correlation of rejection of the duodenum with rejection of the pancreas in a pig model of pancreaticoduodenal transplantation. Transplantation 1993; 56: 1353–1356.

    Article  PubMed  CAS  Google Scholar 

  111. Nakhleh RE, Sutherland DER, Benedetti E, et al. Diagnostic utility and correlation of duodenal and pancreas biopsy tissues in pancreaticoduodenal transplants with emphasis on therapeutic use. Transplant Proc 1995; 27: 1327–1328.

    PubMed  CAS  Google Scholar 

  112. Nakhleh RE, Benedetti E, Gruessner A, et al. Cystoscopic biopsies in pancreaticoduodenal transplantation. Transplantation 1995; 60: 541–546.

    Article  PubMed  CAS  Google Scholar 

  113. Casanova D, Gruessner R, Brayman K, et al. Retrospective analysis of the role of pancreatic biopsy (open and transcystoscopic technique) in the management of solitary pancreas transplants. Transplant Proc 1993; 25: 1192–1193.

    PubMed  CAS  Google Scholar 

  114. Allen RDM, Wilson TG, Grierson JM, et al. Percutaneous biopsy of the bladder-drained pancreas transplants. Transplantation 1991; 51: 1213–1216.

    Article  PubMed  CAS  Google Scholar 

  115. Martinenghi S, Dell’Antonio G, Secchi A, et al. Percutaneous microbiopsy for the diagnosis of rejection in whole bladder-diverted pancreas transplantation. Transplant Proc 1991; 26: 526.

    Google Scholar 

  116. Klassen DK, Hoehn-Saric EW, Weir MR, et al. Isolated pancreas rejection in combined kidney pancreas transplantation. Transplantation 1996; 61: 974–977.

    Article  PubMed  CAS  Google Scholar 

  117. Aideyan OA, Schmidt AJ, Trenkner SW, et al. CT-guided per-cutaneous biopsy of pancreas transplants. Radiology 1996; 201: 825–828.

    PubMed  CAS  Google Scholar 

  118. Lee BC, McGahan JP, Perez RV, et al. The role of percutaneous biopsy in detection of pancreatic transplant rejection. Clin Transplant 2000; 14: 493–498.

    Article  PubMed  CAS  Google Scholar 

  119. Bernardino M, Fernandez M, Neylan J, et al. Pancreatic transplants: CT-guided biopsy. Radiology 1990; 177: 709–711.

    PubMed  CAS  Google Scholar 

  120. Gaber AO, Gaber LW, Shokouh-Amiri MH, et al. Percutaneous biopsy of pancreas transplants. Transplantation 1992; 54: 548550.

    Google Scholar 

  121. Kuhr CS, Davis CL, Barr D, et al. Use of ultrasound and cystoscopically guided pancreatic allograft biopsies and transabdominal renal allograft biopsies: Safety and efficacy in kidney-pancreas transplant recipients. J Urol 1995; 153: 316–321.

    Article  PubMed  CAS  Google Scholar 

  122. Laftavi MR, Gruessner AC, Bland BJ, et al. Diagnosis of pancreas rejection. Cystoscopic transduodenal versus percutaneous computed tomography scan-guided biopsy. Transplantation 1998; 65: 528–532.

    Article  PubMed  CAS  Google Scholar 

  123. Stratta RJ, Taylor RJ, Grune MT, et al. Experience with protocol biopsies after solitary pancreas transplantation. Transplant Proc 1995; 27: 3012–3013.

    PubMed  CAS  Google Scholar 

  124. Stegall MD, Kim DY, Prieto M, et al. Surveillance Biopsies in Solitary Pancreas Transplantation. Acta Chir Austriaca 2001; 33: 6.

    Google Scholar 

  125. West M, Gruessner RWG. Laparoscopic biopsy after pancreaticoduodenal transplantation. Transplantation 1996; 62: 1684 1687.

    Google Scholar 

  126. Silver JM, Vitello JM, Benedetti E. Laparoscopic-guided biopsy of pancreatic transplant allograft. J Lap Adv Surg Tech 1997; 7: 319–322.

    Article  CAS  Google Scholar 

  127. Kayler LK, Merion RH, Rudich SM, Punch JD, Magee JC, Maraschio MA, Leichtman AB, Cibsik DM, Ojo AO, Campbell DA, Arenas JD. Evaluation of pancreatic allograft dysfunction by laparoscopic biopsy. Transplantation 2002; 74: 1287–1289.

    Article  PubMed  Google Scholar 

  128. Egidi MF, Corry RJ, Sugitani A, et al. Enteric-drained pancreas transplants monitored by fine-needle aspiration biopsy. Transplant Proc 1997; 29: 674–675.

    Article  PubMed  CAS  Google Scholar 

  129. Egidi MF, Shapiro R, Khanna A, et al. Fine-needle aspiration biopsy in pancreatic transplantation. Transplant Proc 1995; 27: 3055–3056.

    PubMed  CAS  Google Scholar 

  130. Reinholt FP, Tydén G, Bohman SO, et al. Pancreatic juice cytology in the diagnosis of pancreatic graft rejection. Clin Transplant 1988; 2: 127–133.

    Google Scholar 

  131. Klima G, Margreiter R. Pancreatic juice cytology in the monitoring of pancreas allografts. Transplantation 1989; 48: 980–985.

    Article  PubMed  CAS  Google Scholar 

  132. Klima G, Margreiter R, Konigsrainer A, et al. Pancreatic juice cytology (PJC) for early detection of pancreas allograft rejection. Transplant Proc 1989; 21: 2782–2783.

    PubMed  CAS  Google Scholar 

  133. Radio SJ, Stratta RJ, Taylor RJ, et al. The utility of urine cytology in the diagnosis of allograft rejection after combined pancreas-kidney transplantation. Transplantation 1993; 55: 509–516.

    Article  PubMed  CAS  Google Scholar 

  134. Radio SJ, Stratta RJ, Taylor RJ, et al. Urine cytology monitoring for rejection after vascularized pancreas transplantation. Transplant Proc 1992; 24: 903–906.

    PubMed  CAS  Google Scholar 

  135. Radio SJ, Stratta RJ, Linder J, et al. Histologic confirmation of acute rejection detected by urine cytology in pancreas transplant recipients. Transplant Proc 1994; 26: 529–530.

    PubMed  CAS  Google Scholar 

  136. Kuni CC. Scintigraphy of pancreas transplant. In: Letourneau JG, Day DL, Ascher NL, eds. Radiology of Organ Transplantation. St Louis, MO: Mosby-Yearbook; 1991: 249–256.

    Google Scholar 

  137. Stratta RJ, Sollinger HW, Perlman SB, et al. Early detection of rejection in pancreas transplantation. Diabetes 1989; 38: 63–67.

    PubMed  Google Scholar 

  138. van der Hem LG, van der Linden CJ, Ticheler CHJM, et al. Early detection of post-transplant pancreatic graft dysfunction with technetium-99m-HMPAO scintigraphy. J Nucl Med 1994; 35: 1488–1490.

    PubMed  CAS  Google Scholar 

  139. George EA, Salimi Z, Carney K, et al. Radionuclide surveillance of the allografted pancreas. AJR 1988; 150: 811–816.

    PubMed  CAS  Google Scholar 

  140. Jurewicz WA, Buckels JAC, Dykes JGA, et al. Indium-111 labeled platelets in monitoring pancreatic transplants in humans. Transplant Proc 1984; 16: 720–723.

    PubMed  CAS  Google Scholar 

  141. Catafau AM, Lomena FJ, Ricart MJ, et al. Indium-111-labeled platelets in monitoring human pancreatic transplants. J Nucl Med 1989; 30: 1470–1475.

    PubMed  CAS  Google Scholar 

  142. Patel B, Markivee CR, Manhanta B, et al. Pancreatic transplantation: Scintigraphy, US and CT. Radiology 1988; 167: 685687.

    Google Scholar 

  143. Letourneau JG, Maile CW, Sutherland DER, et al. Ultrasound and computed tomography in the evaluation of pancreatic transplantation. Radiol Clin North Am 1987; 25: 345–355.

    PubMed  CAS  Google Scholar 

  144. Letourneau JG. Sonography, CT, and MM of pancreas allografts. In: Letourneau JG, Day DL, Ascher NL, eds. Radiology of Organ Transplantation. St. Louis, MO: Mosby-Yearbook; 1991: 257–266.

    Google Scholar 

  145. Nghiem DD, Ludrosky L, Young JC. Evaluation of pancreatic circulation by duplex color Doppler flow sonography. Transplant Proc 1994; 26: 466.

    PubMed  CAS  Google Scholar 

  146. Gilabert R, Fernandez-Cruz L, Bru C, et al. Duplex-Doppler ultrasonography in monitoring clinical pancreas transplantation. Transplant Int 1988; 1: 172–177.

    CAS  Google Scholar 

  147. Kubota K, Billing H, Kelter U, et al. Duplex-Doppler ultrasonography for evaluating pancreatic grafts. Transplant Proc 1990; 22: 183.

    PubMed  CAS  Google Scholar 

  148. Aideyan OA, Foshager MC, Benedetti E, et al. Correlation of the arterial resistive index in pancreas transplants of patients with transplant rejection. MR 1997; 168: 1445–1447.

    CAS  Google Scholar 

  149. Nelson NL, Largen PS, Stratta RJ, et al. Pancreas allograft rejection: Correlation of transduodenal core biopsy with Doppler resistive index. Radiology 1996; 200: 91–94.

    PubMed  CAS  Google Scholar 

  150. Wong JJ, Krebs TL, Klassen DK, et al. Sonographic evaluation of acute pancreatic transplant rejection: Morphology-Doppler analysis versus guided percutaneous biopsy. AJR 1996; 166: 803–807.

    PubMed  CAS  Google Scholar 

  151. Moulton JS, Munda R, Weiss MA, et al. Pancreatic transplants: CT with clinical and pathologic correlation. Radiology 1989; 172: 21–26.

    PubMed  CAS  Google Scholar 

  152. Yuh WTC, Hunsicker LG, Sato Y, et al. Application of mag netic resonance imaging in pancreas transplant. Diabetes 1989; 38: 27–29.

    PubMed  Google Scholar 

  153. Contis JC, O’Connor TP, Holland GA, et al. Noninvasive evaluation of bladder-drained whole pancreaticoduodenal transplants with magnetic resonance angiography. Transplant Proc 1994; 26: 464–465.

    PubMed  CAS  Google Scholar 

  154. Krebs T, Daly B, Wong J, et al. The magnetic resonance-derived pancreas to psoas ratio (PPR): Objective and reliable noninvasive diagnosis of pancreatic rejection. Transplant Proc 1995; 27: 3034.

    PubMed  CAS  Google Scholar 

  155. Krebs T, Daly B, Wong-You-Cheong JJ, et al. Acute pancreatic transplant rejection: Evaluation with dynamic contrast-enhanced MR imaging compared with histopathologic analysis. Radiology 1999; 210: 437–442.

    PubMed  CAS  Google Scholar 

  156. Fernandez M, Bernardino ME, Neylan JF, et al. Diagnosis of pancreatic transplant dysfunction: Value of gadopentetate dimeglumine-enhanced MR imaging. MR 1991; 156: 1171 1176.

    Google Scholar 

  157. Kelcz F, Sollinger HW, Pirsh JD. MRI of the pancreas transplant: Lack of correlation between imaging and clinical status. Magn Reson Med 1991; 21: 30–38.

    Article  PubMed  CAS  Google Scholar 

  158. Klassen DK, Weir MR, Schweitzer EJ, et al. Isolated pancreas rejection in combined kidney-pancreas transplantation: Results of percutaneous pancreas biopsy. Transplant Proc 1995; 27: 1333–1334.

    PubMed  CAS  Google Scholar 

  159. Burke GW, Ciancio G, Figueiro J, et al. Can acute rejection be prevented in SPK transplantation? Am J Transplant 2002; 2: 202.

    Google Scholar 

  160. Freise CE, Hirose R, Feng S, et al. Minimal rejection with a steroid sparing protocol in simultaneous pancreas kidney transplantation. Am J Transplant 2002; 2 (supplement 3): 203.

    Article  Google Scholar 

  161. Sutherland DER, Gruessner RWG, Humar A, et al. Pre-tx immunosuppression (IS) for pancreas (PX) transplants (TXS) alone (PTA) in non-uremic diabetic recipients. Am J Transplant 2002; 2 (supplement 3): 141.

    Google Scholar 

  162. Lo A, Stratta RJ, Egidi MF, et al. Outcome of simultaneous kidney-pancreas transplantation in African-American recipients: A case control study. Transplant Proc 2001; 33: 1675 1677.

    Google Scholar 

  163. Ciancio G, Burke GW, Gomez C, et al. Simultaneous pancreas-kidney transplantation in Hispanic recipients with type 1 diabetes mellitus and end-stage renal disease. Transplant Proc 1997; 29: 3717.

    Article  PubMed  CAS  Google Scholar 

  164. Gruessner A. Analysis of the International Pancreas Transplant Registry (IPTR). Personal communication; February 2002.

    Google Scholar 

  165. Odorico JS, Becker YT, Groshek M, et al. Improved solitary pancreas transplant graft survival in the modern immunosuppressive era. Cell Transplant 2000; 9: 919–927.

    PubMed  CAS  Google Scholar 

  166. Gruessner RWG, Sutherland DER, Najarian JS, et al. Solitary pancreas transplantation for nonuremic patients with labile insulin-dependent diabetes mellitus. Transplantation 1997; 64: 1572–1577.

    Article  PubMed  CAS  Google Scholar 

  167. Gruessner AC, Sutherland DER, Dunn DL, et al. Pancreas after kidney transplants in posturemic patients with type 1 diabetes mellitus. J Am Soc Nephrol 2001; 12: 2490–2499.

    PubMed  CAS  Google Scholar 

  168. Sutherland DER, Gruessner RWG, Dunn DL, et al. Lessons learned from more than 1,000 pancreas transplants at a single institution. Ann Surg 2001; 233: 463–501.

    Article  PubMed  CAS  Google Scholar 

  169. Gruessner AC, Sutherland DER, Gruessner RWG. Enteric versus bladder drainage for solitary pancreas transplants-a registry report. Transplant Proc 2001; 33: 1678–1680.

    Article  PubMed  CAS  Google Scholar 

  170. Drachenberg CB, Papadimitriou JC, Farney A, et al. Pancreas transplantation: The histologic morphology of graft loss and clinical correlations. Transplantation 2001; 71: 1784–1791.

    Article  PubMed  CAS  Google Scholar 

  171. Papadimitriou J, Drachenberg C, Klassen D, et al. Histologic chronic pancreas allograft rejection: Correlation with previous acute rejection episodes. Am J Transplant 2002; 3: 202.

    Google Scholar 

  172. Odorico JS, Pirsch JD, Becker YT, et al. Results of solitary pancreas transplantation with enteric drainage: Is there a benefit from monitoring urinary amylase levels? Transplant Proc 2001; 33: 1700.

    Article  PubMed  CAS  Google Scholar 

  173. Zantvoort FA, Persijn GG, vanRood JJ. Renal allograft and patient survival in combined pancreas/kidney transplantation. Transplant Proc 1989; 21: 2831–2832.

    PubMed  CAS  Google Scholar 

  174. Hillebrand G, Castro LA, Landgraf R, et al. Combined kidney/pancreas transplantation-poor long-term outcome of renal grafts. Transplant Proc 1987; 19: 3909–3910.

    PubMed  CAS  Google Scholar 

  175. Cheung AHS, Sutherland DER, Gillingham KJ, et al. Simultaneous pancreas-kidney transplant versus kidney transplant alone in diabetic patients. Kidney Int 1992; 41: 924–929.

    Article  PubMed  CAS  Google Scholar 

  176. Sollinger HW, Stratta RJ, D’Alessandro AM, et al. Experience with simultaneous pancreas-kidney transplantation. Ann Surg 1988; 208: 475–483.

    Article  PubMed  CAS  Google Scholar 

  177. Odorico JS, Rayhill SC, Heisey DM, et al. Immunologic risks of combined kidney-pancreas transplantation. Transplant Proc 1998; 30: 249–250.

    Article  PubMed  CAS  Google Scholar 

  178. Schulak JA, Mayes JT, Hricik DE. Kidney transplantation in diabetic patients undergoing combined kidney-pancreas or kidney-only transplantation. Transplantation 1992; 53: 685–687.

    PubMed  CAS  Google Scholar 

  179. Rosen CB, Frohnert PP, Velosa JA, et al. Morbidity of pancreas transplantation during cadaveric renal transplantation. Transplantation 1991; 51: 123–127.

    Article  PubMed  CAS  Google Scholar 

  180. Hiesse C, Paradis V, Benoît G, Kriaa F, Blanchet P, Bellamy J, Larue JR, Charpentier B, et al. Analysis of incidence and pattern of acute rejection episodes after simultaneous pancreas and kidney transplantation. Transplant Proc 1997; 29: 671–672.

    Article  PubMed  CAS  Google Scholar 

  181. Boonstra JC, van der Pijl H, van der Woude FJ, et al. The incidence of interstitial and vascular kidney rejection after pancreas-kidney transplantation. J Am Soc Nephrol 1995; 5: 1918 1925.

    Google Scholar 

  182. Hedman L, Frisk B, Brynger H, et al. Severe kidney graft rejection in combined kidney and pancreas transplantation. Transplant Proc 1987; 19: 3911–3912.

    PubMed  CAS  Google Scholar 

  183. Cantarovich D, Giral M, Josien R, et al. Incidence and impact of acute rejection episodes on short-and long-term graft survival in recipients of simultaneous pancreas-kidney transplantation. Transplant Proc 1995; 27: 1319.

    PubMed  CAS  Google Scholar 

  184. Cantarovich D, Hourmant M, Dantal J, et al. OKT3 first-line treatment of acute rejection episodes following combined pancreas and kidney transplantation. Transplant Proc 1994; 26: 549.

    PubMed  CAS  Google Scholar 

  185. Hricik DE, Phinney MS, Weigel KA, et al. Long-term renal function in type I diabetics after kidney or kidney-pancreas transplantation. Transplantation 1997; 64: 1283–1288.

    Article  PubMed  CAS  Google Scholar 

  186. Rayhill SC, D’Alessandro AM, Odorico JS, et al. Simultaneous pancreas-kidney transplantation and living related donor renal transplantation in patients with diabetes: Is there a difference in survival? Ann Surg 2000; 231: 417–423.

    Article  PubMed  CAS  Google Scholar 

  187. Gruessner RWG, Dunn DL, Tzardis PJ, et al. An immunological comparison of pancreas transplants alone in nonuremic patients versus simultaneous pancreas/kidney transplants in uremic diabetic patients. Transplant Proc 1990; 22: 1581.

    PubMed  CAS  Google Scholar 

  188. Bartlett ST, Schweitzer EI, Johnson LB, et al. Equivalent success of simultaneous pancreas kidney and solitary pancreas transplantation. A prospective trial of tacrolimus immunosuppression with percutaneous biopsy. Ann Surg 1996; 224: 440–452.

    Article  PubMed  CAS  Google Scholar 

  189. Tyden G, Tibell A, Bolinder J, et al. High incidence of late rejections in preuremic recipients of pancreas transplants given alone or in combination with renal transplants. Transplant Proc 1990; 22: 1582–1583.

    PubMed  CAS  Google Scholar 

  190. Stratta RJ. Late acute rejection episodes after vascularized pancreas transplantation. Transplant Proc 1998; 30: 1560–1561.

    Article  PubMed  CAS  Google Scholar 

  191. Walker JA, Klassen DK, Hooper FJ, et al. Late pancreas allograft rejection. Preliminary experience with factors predisposing to rejection. Transplantation 1996; 62: 539–543.

    Article  PubMed  CAS  Google Scholar 

  192. Dawidson I, Ar’Rajab A, Lu C, et al. Cyclosporine blood levels predict the likelihood of rejection and toxicity after simultaneous pancreas-kidney transplantation. Transplant Proc 1995; 27: 1324–1326.

    PubMed  CAS  Google Scholar 

  193. Gruessner AC, Sutherland DER. Analysis of United States (US) and non-US pancreas transplant reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). In: Cecka M, Teraski PI, eds. Clinical Transplants 2000. Los Angeles: UCLA Immunogenetics Center. 2002, pp 41–72.

    Google Scholar 

  194. Gruessner RWG, Nakhleh R, Tzardis P, et al. Differences in rejection grading after simultaneous pancreas and kidney transplantation in pigs. Transplantation 1994; 57: 1021–1028.

    PubMed  CAS  Google Scholar 

  195. Nakhleh RE, Sutherland DER, Tzardis P, et al. Correlation of rejection of the duodenum with rejection of the pancreas in a pig model of pancreaticoduodenal transplantation. Transplantation 1993; 56: 1353–1356.

    Article  PubMed  CAS  Google Scholar 

  196. Gruessner RWG, Nakhleh R, Tzardis PJ, et al. Correlation between duodenal and kidney rejection: A histologic comparative study in a pig model of panreaticoduodenal-kidney transplantation. Transplant Proc 1994; 26: 541–543.

    PubMed  CAS  Google Scholar 

  197. Gruessner RWG, Nakhleh R, Tzardis P, et al. Rejection patterns after simultaneous pancreaticoduodenal-kidney transplants in pigs. Transplantation 1994; 57: 756–760.

    Article  PubMed  CAS  Google Scholar 

  198. Severyn W, Olson L, Miller J, et al. Studies on the survival of simultaneous canine renal and segmental pancreatic allografts. Transplantation 1982; 33: 606–612.

    Article  PubMed  CAS  Google Scholar 

  199. Florack G, Sutherland DER, Sibley RK, et al. Combined kidney and segmental pancreas allotransplantation in dogs. Transplant Proc 1985; 17: 374–377.

    Google Scholar 

  200. Nakai I, Kaufman DB, Field MR, et al. Differential effects of preexisting uremia and a synchronous kidney graft on pancreas allograft functional survival in rats. Transplantation 1992; 54: 17–25.

    Article  PubMed  CAS  Google Scholar 

  201. Vogt P, Hiller WFA, Steiniger B, et al. Differential response of kidney and pancreas rejection to cyclosporine immunosuppression. Transplantation 1992; 53: 1269–1272.

    Article  PubMed  CAS  Google Scholar 

  202. Reddy KS, Davies D, Ormond D, et al. Impact of acute rejection episodes on the long-term graft survival in kidney-pancreas transplant recipients. Acta Chir Austriaca 2001; 33: 14.

    Google Scholar 

  203. Lawrence JS. Uremia: Nature’s immunosuppressive device. Ann Int Med 1965; 2: 166–168.

    Google Scholar 

  204. Wilson WEC, Kirkpatrick CH, Talmage DW. Suppression of immunologic responsiveness in uremia. Ann Intern Med 1965; 62: 1.

    Google Scholar 

  205. Hayry P, Von Willebrand E, Hockerstedt K, et al. Is uremia immunosuppressive in renal transplantation? Transplantation 1982; 34: 268.

    Article  PubMed  CAS  Google Scholar 

  206. Stratta RJ, Taylor RJ, Ozaki CF, et al. A comparative analysis of results and morbidity in type I diabetics undergoing preemptive versus postdialysis combined pancreas-kidney transplantation. Transplantation 1993; 55: 1097–1103.

    Article  PubMed  CAS  Google Scholar 

  207. Margreiter R, Klima G, Bömüller C, et al. Rejection of kidney and pancreas after pancreas-kidney transplantation. Diabetes 1989; 38: 79–81.

    PubMed  Google Scholar 

  208. Dubernard JM, Traeger J, LaRocca E, et al. Experience of the Hopital Edouard Herriot, University of Lyon I, Lyon, France. In: Dubernard JM, Sutherland DER, eds. International Handbook of Pancreas Transplantation 1989. Dordrecht, The Netherlands: Kluwer; 1989: 389–398.

    Chapter  Google Scholar 

  209. Tesi RJ, Henry ML, Eklhammas EA, et al. The frequency of rejection episodes with combined kidney-pancreas transplant-the impact on survival. Transplantation 1994; 58: 424–430.

    Article  PubMed  CAS  Google Scholar 

  210. Gruessner RWG, Najarian JS, Gruessner A, et al. Comparison of rejection in clinical transplantation of pancreas alone or associated with kidney transplant. In: Touraine JL, Traeger J, Betuel H, et al., eds. Transplantation and Clinical Immunology: Multiple Transplants. vol. 22. Excerpta Medica, Amsterdam; 1991: 47–54.

    Google Scholar 

  211. Shapiro R, Jordan ML, Scantlebury VP, et al. Renal allograft rejection with normal renal function in simultaneous kidney/ pancreas recipients. Does dyssynchronous rejection really exist? Transplantation 2000; 69: 440 141.

    Google Scholar 

  212. Lillehei RC, Ruiz JO, Acquino C, et al. Transplantation of the pancreas. Acta Endocrinol 1976; 83 (suppl 205): 303–320.

    Google Scholar 

  213. Sollinger HW, Ploeg RJ, Eckhoff DE, et al. Two hundred consecutive simultaneous pancreas-kidney transplants with bladder drainage. Surgery 1993; 114: 736–744.

    PubMed  CAS  Google Scholar 

  214. Sutherland DER, Gruessner R, Moundry-Munns K, et al. Discordant graft loss from rejection of organs from the same donor in simultaneous pancreas-kidney recipients. Transplant Proc 1995; 2: 907–908.

    Google Scholar 

  215. Stratta RJ, Taylor RJ, Bynon JS, et al. Patterns of rejection after combined pancreas-kidney transplantation. Transplant Proc 1994; 26: 524–525.

    PubMed  CAS  Google Scholar 

  216. Stratta RJ. Patterns of graft loss following simultaneous kidney-pancreas transplantation. Transplant Proc 1998; 30: 288.

    Article  PubMed  CAS  Google Scholar 

  217. Chinnakotla S, Taylor RJ, DeRoover A, et al. Fate of the pancreas after asynchronous kidney loss in patients undergoing simultaneous kidney/pancreas transplantation. Transplant Proc 2001; 33: 1696–1697.

    Article  PubMed  CAS  Google Scholar 

  218. Kyriakides G, Olson L, Severyn W, et al. Early detection of pancreatic allograft rejection in dogs: Immunologic and physiologic monitoring in simultaneous kidney and pancreas transplantation and response in immunosuppression. World J Surg 1981; 5: 430.

    Google Scholar 

  219. Boonstra JG, Deckers JGM, Laterveer JC, et al. Pancreas and kidney allograft-infiltrating cells in simultaneous pancreas-kidney transplantation. Transplantation 1997; 63: 1470–1475.

    Article  PubMed  CAS  Google Scholar 

  220. Hiller W, Klempnauer J, Vogt P, et al. Relevance of non-major histocompatibility complex antigens in pancreas transplantation. Transplant Proc 1987; 19: 4274–4275.

    PubMed  CAS  Google Scholar 

  221. Basadonna GP, Auersvald LA, Oliveira SC, et al. Pancreas after kidney transplantation: HLA mismatch does not preclude success. Transplant Proc 1997; 29: 667.

    Article  PubMed  CAS  Google Scholar 

  222. Gruber SA, Katz S, Kaplan B, et al. Initial results of solitary pancreas transplants performed without regard to donor/recipient HLA mismatching. Transplantation 2000; 70: 388–391.

    Article  PubMed  CAS  Google Scholar 

  223. Gruessner AC, Sutherland DER, Gruessner RWG. Matching in pancreas transplantation-a registry analysis. Transplant Proc 2001; 33: 1665–1666.

    Article  PubMed  CAS  Google Scholar 

  224. Gruessner AC, Sutherland DER, Gruessner RWG. The impact of CREG matching on pancreas (PA) transplant (TX) outcome: A registry analysis. Am J Transplant 2002; 3: 170.

    Google Scholar 

  225. Cantor HM, Dumont AE. Hepatic suppression of sensitization to antigen absorbed into the portal system. Nature 1967; 215: 744–755.

    Article  PubMed  CAS  Google Scholar 

  226. Caine RY. Immunological tolerance-the liver effect. Immunological Reviews 2000; 174: 280–282.

    Article  Google Scholar 

  227. Starzl TE, Murase N, Demetris A, et al. The mystique of hepatic olerogenicity. Sem Liver Dis 2000; 20: 497–510.

    Article  CAS  Google Scholar 

  228. Caine RY, Sells RA, Pena JR, et al. Tolerogenic effects of porcine liver allografts. Br J Surg 1969; 56: 692–693.

    Article  Google Scholar 

  229. Nymann T, Hathaway DK, Shokouh-Amiri MH, et al. Patterns of acute rejection in portal-enteric versus systemic-bladder pancreas-kidney transplantation: A retrospective study. Clin Transplant 1998; 122: 175–183.

    Google Scholar 

  230. Philosophe B, Farney AC, Schweitzer EJ, et al. Superiority of portal venous drainage over systemic venous drainage in pancreas transplantation. Clin Transplant 1998; 12: 175–183.

    Google Scholar 

  231. McGilvray I, Humar A, Dixon E, et al. Portal venous drainage of pancreas grafts is associated with lower rate of acute rejection. Am J Transplant 2002; 2: 142.

    Article  Google Scholar 

  232. Petruzzo P, DaSilva M, Feitosa LC, et al. Simultaneous pancreas-kidney transplantation: Portal versus systemic venous drainage of the pancreas allografts. Clin Transplant 2000; 14: 287–292.

    Article  PubMed  CAS  Google Scholar 

  233. Stratta RJ, Shoukouh-Amiri MH, Egidi MF, et al. A prospective comparison of simultaneous kidney-pancreas transplantation with systemic-enteric versus portal-enteric drainage. Ann Surg 2001; 233: 740–751.

    Article  PubMed  CAS  Google Scholar 

  234. Brayman K, Morel P, Chau C, et al. Influence of rejection episodes on the relationship between exocrine and endocrine function in bladder-drained pancreas transplants. Transplant Proc 1992; 24: 921–923.

    PubMed  CAS  Google Scholar 

  235. Sibley RK, Sutherland DER. Pancreas transplantation: An immunohistologic examination of 100 grafts. Am J Pathol 1987; 128: 151–170.

    Google Scholar 

  236. Barone GW, Henry ML, Elkhammas EA, et al. Pancreatic exocrine “burnout” following pancreas transplantation. Transplant Proc 1992; 24: 831–832.

    PubMed  CAS  Google Scholar 

  237. Barrou B, Barrou Z, Gruessner A, et al. Probability of retaining endocrine function (insulin independence) after definitive loss of exocrine function in bladder-drained pancreas transplants. Transplant Proc 1994; 26: 473–474.

    PubMed  CAS  Google Scholar 

  238. Gruessner RWG, Manivel C, Dunn DL, et al. Pancreaticoduodenal transplantation with enteric drainage following native total pancreatectomy for chronic pancreatitis. Pancreas 1991; 6: 479–488.

    Article  PubMed  CAS  Google Scholar 

  239. Esterl RM, Stratta RJ, Taylor RJ, et al. Rejection with duodenal rupture after solitary pancreas transplantation: An unusual cause of severe hematuria. Clin Transplant 1995; 9: 155–159.

    PubMed  CAS  Google Scholar 

  240. Sutherland DER. Immunosuppression for clinical pancreas transplantation. Clin Transplant 1991; 5 (special issue): 549–553.

    Google Scholar 

  241. Gruessner RWG. Tacrolimus in pancreas transplantation. A multicenter analysis. Clin Transplant 1997; 11: 299–312.

    PubMed  CAS  Google Scholar 

  242. Sollinger HW, Odorico JS, Knechtle SH, et al. Experience with 500 simultaneous pancreas-kidney transplants. Ann Surg 1998; 228: 284–296.

    Article  PubMed  CAS  Google Scholar 

  243. Papadimitriou JC, Wiland A, Drachenberg CB, et al. Effectiveness of immunosuppressive treatment for recurrent or refractory pancreas allograft rejection: Correlation with histologic grade. Transplant Proc 1998; 30: 3945.

    Article  PubMed  CAS  Google Scholar 

  244. Gruessner RWG, Sutherland DER, Drangstveit MB, et al. Use of FK 506 in pancreas transplantation. Transplant Int 1996; 9: 5251–5257.

    Article  Google Scholar 

  245. Desai DM, Scandling JD, Knoppel C, et al. Low-dose OKT3 treatment for rejection/induction in kidney and kidney-pancreas transplantation. Transplant Proc 1998; 30: 1552–1554.

    Article  PubMed  CAS  Google Scholar 

  246. Stratta RJ, SoRinger HS, D’Alessandro AM, et al. OKT3 rescue therapy in pancreas allograft rejection. Diabetes 1989; 38: 74–78.

    PubMed  Google Scholar 

  247. Peddi VR, Kamath S, Schroeder TJ, et al. Efficacy of OKT3 as primary therapy for histologically confirmed acute renal allograft rejection in simultaneous kidney and pancreas transplant recipients. Transplant Proc 1998; 30: 285–287.

    Article  PubMed  CAS  Google Scholar 

  248. Stratta RJ. Benefits and risks of early antilymphocyte rescue in simultaneous kidney-pancreas transplant recipients. Transplant Proc 1998; 30: 525.

    Article  PubMed  CAS  Google Scholar 

  249. Cantarovich D, Hourmant M, Dantal J, et al. OKT3 first-line treatment of acute rejection episodes following combined pancreas and kidney transplantation. Transplant Proc 1994; 26: 549.

    PubMed  CAS  Google Scholar 

  250. Gruessner RWG, Burke GW, Stratta R, et al. A multicenter analysis of the first experience with FK 506 for induction and rescue therapy after pancreas transplantation. Transplantation 1996; 61; 261–273.

    Article  PubMed  CAS  Google Scholar 

  251. Gruessner RWG, Sutherland DER, Drangstveit MB, et al. Mycophenolate mofetil in pancreas transplantation. Transplantation 1998; 66: 318–323.

    Article  PubMed  CAS  Google Scholar 

  252. Ciancio G, Burke GW, Roth D, et al. Use of intravenous FK506 to treat acute rejection in simultaneous pancreas-kidney transplant recipients on maintenance oral FK506. Transplantation 1997; 63: 785–788.

    Article  PubMed  CAS  Google Scholar 

  253. Ciancio G, Burke G, Viciana A, et al. Use of intravenous tacrolimus to reverse vascular rejection in kidney and simultaneous kidney-pancreas transplantation. Transplant Proc 1998; 30: 1536–1537.

    Article  PubMed  CAS  Google Scholar 

  254. Stratta RJ, Taylor RJ, Castaldo P, et al. FK 506 induction and rescue therapy in pancreas transplant recipients. Transplant Proc 1996; 28: 991–992.

    PubMed  CAS  Google Scholar 

  255. Washburn WK, Shaffer D, Simpson MA, et al. Tacrolimus rescue therapy for renal allograft rejection refractory to cyclosporine-based immunosuppression. Transplant Proc 1996; 28: 1015–1016.

    PubMed  CAS  Google Scholar 

  256. Becker G, Witzke O, Friedrich J, et al. Rescue therapy with tacrolimus in simultaneous pancreas/kidney transplantation. Transplant Int 1997; 10: 51–54.

    Article  CAS  Google Scholar 

  257. Hariharan S, Peddi VR, Munda R, et al. Long-term renal and pancreas function with tacrolimus rescue therapy following kidney/pancreas transplantation. Transplant Proc 1997; 29: 652–653.

    Article  PubMed  CAS  Google Scholar 

  258. Troppmann C, Gruessner RWG, Dunn DL, et al. Is transplant pancreatectomy after graft failure necessary? Transplant Proc 1994; 36: 455.

    Google Scholar 

  259. Stratta RJ, Gaber AO, Shokouh-Amiri MH, et al. Allograft pancreatectomy after pancreas transplantation with systemic-bladder versus portal-enteric drainage. Clin Transplant 1999; 13: 465–472.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Rainer W. G. Gruessner
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Minnesota, 55455, Minneapolis, Minnesota, USA

    Rainer W. G. Gruessner MD (Professor) & David E. R. Sutherland MD, PhD (Professor) (Professor) &  (Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer Science+Business Media New York

About this chapter

Cite this chapter

Gruessner, R.W.G. (2004). Immunobiology, Diagnosis, and Treatment of Pancreas Graft Rejection. In: Gruessner, R.W.G., Sutherland, D.E.R. (eds) Transplantation of the Pancreas. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-4371-5_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-4371-5_11

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1830-7

  • Online ISBN: 978-1-4757-4371-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation