Pancreas Graft Pathology

  • Raouf E. Nakhleh


Solid-organ pancreas transplants are performed to alleviate signs and symptoms of diabetes mellitus, control blood glucose levels, and slow the progress of secondary complications.1,2 Many serological tests have been devised to monitor pancreas function.3–5 The vast majority of these tests indicate dysfunction and may correlate with severity, but none of them specifically show pancreas allograft rejection. Tissue diagnosis remains the gold standard for determining the presence of rejection.6–9 Other pathologic processes such as infection may be diagnosed by other means, but tissue diagnosis is frequently needed to confirm those results and exclude rejection.


Acute Pancreatitis Acute Rejection Chronic Rejection Pancreas Transplant Hyperacute Rejection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Abendroth D, Landgraf R, Illner WD, Land W. Beneficial effect of pancreatic transplantation in insulin dependent diabetes mellitus patients. Transplant Proc 1990; 22: 696–697.PubMedGoogle Scholar
  2. 2.
    Bolinder J, Tyden G, Tibell A, Groth, CG. Long-term metabolic control after pancreatic transplantation with enteric exocrine diversion. Diabetologia 1991; 34 (suppl): S76 — S80.PubMedCrossRefGoogle Scholar
  3. 3.
    Kernstad R, Tyden G, Brattstrom C, et al. Pancreas-specific protein new serum marker for graft rejection in pancreas transplant recipients. Diabetes 1989; 38 (suppl 1): 55–56.Google Scholar
  4. 4.
    Marks WH, Borgstrom A, Sollinger H, Marks C. Serum immunoreactive anodal trypsinogen and urinary amylase as biochemical markers for rejection of clinical whole-organ pancreas allografts having exocrine drainage into the urinary bladder. Transplantation 1990; 49: 112–115.PubMedCrossRefGoogle Scholar
  5. 5.
    Prieto M, Sutherland DER, Fernandez Cruz L, Heil J, Najarian JS. Experimental and clinical experience with urine amylase monitoring for early diagnosis of rejection in pancreas transplantation. Transplantation 1987; 43: 73–79.PubMedCrossRefGoogle Scholar
  6. 6.
    Papadimitriou JC, Drachenberg CB, Wiland A, et al. Histologic grading of acute allograft rejection in pancreas needle biopsy: Correlation to serum enzymes, glycemia, and response to immunosuppressive treatment. Transplantation 1998; 66: 1741–1745.PubMedCrossRefGoogle Scholar
  7. 7.
    Carpenter HA, Engen DE, Munn SR, et al. Histologic diagnosis of rejection by using cystoscopically directed needle biopsy specimens from dysfunctional pancreaticoduodenal allografts with exocrine drainage into the bladder. Am J Surg Pathol 1990; 14: 837–846.PubMedCrossRefGoogle Scholar
  8. 8.
    Drachenberg CB, Klassen DK, Weir MR, et al. Islet cell damage associated with tacrolimus and cyclosporine: Morphological features in pancreas allograft biopsies and clinical correlation. Transplantation 1999; 68: 396–402.PubMedCrossRefGoogle Scholar
  9. 9.
    Nakhleh R, Sutherland DER. Pancreas Rejection: Significance of histopathologic findings with implications for classification of rejection. Am J Surg Pathol 1992; 16: 1098–1107.Google Scholar
  10. 10.
    Gruessner AC, Sutherland DER. Report for the International Pancreas Transplant Registry-2000. Transplant Proc 2000; 33: 1643–1646.CrossRefGoogle Scholar
  11. 11.
    Groth CG, Tyden G, Ostman J Fifteen years’ experience with pancreas transplantation with pancreatico-enterostomy. Diabetes 1989; 38 (suppl 1): 13–15.PubMedGoogle Scholar
  12. 12.
    Sollinger HW, Sratta RJ, Kalayoglu M, Pirsch JD, Belzer FO. Pancreas transplantation with pancreatiococystostomy and quadruple immunosuppression. Surgery 1987; 102: 674–679.PubMedGoogle Scholar
  13. 13.
    Dubernard JM, Tradger J, Neyra P, et al. A new method of preparation of segmental pancreatic grafts for transplantation and trials in dogs and in man. Surgery 1978; 84: 633–639.PubMedGoogle Scholar
  14. 14.
    Carpenter HA, Engen DE, Munn SR, et al. Histologic features of rejection in cystoscopically directed needle biopsies of pancreaticoduodenal allografts in dogs and humans. Transplant Proc 1990; 22: 707–708.PubMedGoogle Scholar
  15. 15.
    Drachenberg C, Klassen D, Bartlett S, et al. Histologic grading of pancreas acute allograft rejection in percutaneous needle biopsies. Transplant Proc 1996; 28: 512–513.PubMedGoogle Scholar
  16. 16.
    Laftavi MR, Gruessner AC, Bland BJ, et al. Diagnosis of pancreas rejection: cystoscopie transduodenal versus percutaneous computed tomography scan-guided biopsy. Transplantation 1998; 65: 528–532.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    West M, Gruessner RW. Laparoscopic biopsy after pancreaticoduodenal transplantation. A first report. Transplantation 1996; 62: 1684–1687.Google Scholar
  19. 19.
    Gruessner RW, Dunn DL, Tzardis PJ, Tomadze G, MoudryMunns KC, Matas AJ, Najarian JS, Sutherland DE. 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 (2): 622–623.PubMedGoogle Scholar
  20. 20.
    Hiesse C, Paradis V, Benoit G, et al. Analysis of incidence and pattern of acute rejection episodes after simultaneous pancreas and kidney transplantation. Transplant Proc 1997; 29: 671–672.PubMedCrossRefGoogle Scholar
  21. 21.
    Klassen DK, Weir MR, Schweitzer EJ, Bartlett ST. Isolated pancreas rejection in combined kidney-pancreas transplantation: Results of percutaneous pancreas biopsy. Transplant Proc 1995; 27: 1333–1334.PubMedGoogle Scholar
  22. 22.
    Sutherland DE, Gruessner R, Moudry-Munns K, Gruessner A. Discordant graft loss from rejection of organs from the same donor in simultaneous pancreas-kidney recipients. Transplant Proc 1995; 27: 907–908.PubMedGoogle Scholar
  23. 23.
    Sibley RK, Sutherland DE. Pancreas transplantation. An immunohistologic and histopathologic examination of 100 grafts. Am J Pathol 1987; 128: 151–170.PubMedGoogle Scholar
  24. 24.
    Drachenberg CB, Papadimitriou JC, Klassen DK, et al. Distribution of alpha and beta cells in pancreas allograft biopsies: Correlation with rejection and other pathologic processes. Transplant Proc 1998; 30: 665–666.PubMedCrossRefGoogle Scholar
  25. 25.
    Nakhleh R, Gruessner RWG, Tzardis PJ, Dunn D, Sutherland DER. Pathology of transplanted human duodenal tissue: A histologic study, with comparison to pancreatic pathology in resected pancreaticoduodenal transplants. Clin Transplant 1991; 5: 241–247.Google Scholar
  26. 26.
    Ekberg H, Deane SA, Williamson P, et al. Long-term duct-occluded segmental pancreatic autografts. Does fibrosis lead to graft loss? Transplantation 1988; 46: 21–25.PubMedCrossRefGoogle Scholar
  27. 27.
    Shah KH, Bitter-Suermann H, Save-Soderbergh J. Morphological findings in duct-ligated pancreas grafts in the rat. An analysis of isografts, allografts, and long-standing allografts in hosts conditioned by previous spleen allograft. Transplantation 1980; 30: 83–89.PubMedCrossRefGoogle Scholar
  28. 28.
    Papadimitriou JC, Klassen DK, Ioffe OB, Bartlett ST, Hebel JR, Drachenberg CB. Identification of histological features differentiating pancreatic allograft rejection from nonrejection-related pathology in needle biopsies. Transplant Proc 1997; 29: 679.PubMedCrossRefGoogle Scholar
  29. 29.
    Carpenter HA, Barr D, Marsh CL, Miller AR, Perkins JD. Sequential histopathologic changes in pancreaticoduodenal allograft rejection in dogs. Transplantation 1989; 48: 764–768.PubMedCrossRefGoogle Scholar
  30. 30.
    Nakhleh RE, Gruessner RW, Swanson PE, et al. Pancreas transplant pathology. A morphologic, immunohistochemical, and electron microscopic comparison of allogeneic grafts with rejection, syngeneic grafts, and chronic pancreatitis. Am J Surg Pathol 1991; 15: 246–256.PubMedCrossRefGoogle Scholar
  31. 31.
    Nakhleh RE, Gruessner RW, Tzardis PJ, Brayman K, Dunn DL, Sutherland DE. Pancreas transplant pathology: An imraunohistochemical comparison of allografts with rejection, syngeneic grafts, and chronic pancreatitis. Transplant Proc 1991; 23: 1598–1599.PubMedGoogle Scholar
  32. 32.
    Nakhleh RE, Sutherland DE. Biopsies from pancreas allografts at time of dysfunction: Pathologic comparison of allografts which ultimately failed versus those which continued to function. Transplant Proc 1993; 25: 1194–1195.PubMedGoogle Scholar
  33. 33.
    Nakhleh RE, Gruessner RWG. Ischemia due to vascular rejection causes islet loss after pancreas transplantation. Transplant Proc 1998; 30: 539–540.PubMedCrossRefGoogle Scholar
  34. 34.
    Drachenberg CB, Papadimitriou JC, Klassen DK, et al. Evaluation of pancreas transplant needle biopsy: Reproducibility and revision of histologic grading system. Transplantation 1997; 63: 1579–1586.PubMedCrossRefGoogle Scholar
  35. 35.
    Paul LC. Current knowledge of the pathogenesis of chronic allograft dysfunction. Transplant Proc 1999; 31 (4): 1793–1795.PubMedCrossRefGoogle Scholar
  36. 36.
    Paul LC. Pathophysiology of chronic renal allograft rejection. Transplant Proc 1999; 31 (7): 2715–2716.PubMedCrossRefGoogle Scholar
  37. 37.
    Drachenberg CB, Papadimitriou JC, Klassen DK, et al. Chronic pancreas allograft rejection: Morphologic evidence of progression in needle biopsies and proposal of a grading scheme. Transplant Proc 1999; 31: 614.PubMedCrossRefGoogle Scholar
  38. 38.
    Konigsrainer A, Mark W, Hechenleitner P, et al. At what stage does pancreas allograft rejection become irreversible? Transplantation 1997; 63: 631–635.PubMedCrossRefGoogle Scholar
  39. 39.
    Papadimitriou JC, Drachenberg CB, Klassen DK, et al. Revised histologic grading scheme for chronic pancreas allograft rejection in core needle biopsies: Prognostic significance. Presented at the annual meeting of the American Society of Transplantation; May 2001; Chicago. Abstract.Google Scholar
  40. 40.
    Sibley RK, Sutherland DE, Goetz F, Michael AF. Recurrent diabetes mellitus in the pancreas iso-and allograft. A light and electron microscopic and immunohistochemical analysis of four cases. Lab Invest 1985; 53: 132–144.PubMedGoogle Scholar
  41. 41.
    Tyden G, Finn PR, Sindkrist G, Bolinger J. Recurrence of autoimmune diabetes mellitus in recipients of cadaveric pancreatic grafts. N Engl J Med 1996; 335: 860–863.PubMedCrossRefGoogle Scholar
  42. 42.
    Egidi MF, Corry RJ, Sugitani A, et al. Enteric-drained pancreas transplants monitored by fine-needle aspiration biopsy. Transplant Proc 1997; 29: 674–675.PubMedCrossRefGoogle Scholar
  43. 43.
    Egidi MF, Shapiro R, Khanna A, Fung JJ, Corry RJ. Fine-needle aspiration biopsy in pancreatic transplantation. Transplant Proc 1995; 27: 3055–3056.PubMedGoogle Scholar
  44. 44.
    Kubota K, Reinholt FP, Tyden G, Bohman SO, Groth CG. Cytologic patterns in juice from human pancreatic transplants: Correlation with histologic findings in the graft. Surgery 1991; 109: 507–514.PubMedGoogle Scholar
  45. 45.
    Suzuki Y, Kuroda Y, Tanioka Y, et al. Peripancreatic fluid cytology: Detection of early rejection versus graft pancreatitis after canine pancreatic transplantation. World J Surg 1997; 21: 880884.Google Scholar
  46. 46.
    Drachenberg CB, Abruzzo LV, Klassen DK, et al. Epstein-Barr virus-related posttransplantation lymphoproliferative disorder involving pancreas allograft: Histological differential diagnosis from acute allograft rejection. Human Pathol 1998; 29: 569–577.CrossRefGoogle Scholar
  47. 47.
    Kimball P, Ham J, Eisenberg M, et al. Lethal graft-versus-host disease after simultaneous kidney–pancreas transplantation. Transplantation 1997; 63: 1685–1688.PubMedCrossRefGoogle Scholar
  48. 48.
    Wijkstrom M, Sutherland DER, Paraskevas S, Humar A, Gruessner RW, Kandaswamy R. GVHD (graft versus host disease) in pancreas transplantation—rare but lethal. Presented at the annual meeting of the American Society of Transplantation; May 2001; Chicago. Abstract.Google Scholar
  49. 49.
    Jindal RM, Hjelmesaeth J. Impact and management of post-transplant diabetes mellitus. Transplantation 2000;70(suppl): SS58–63.Google Scholar
  50. 50.
    Jindal RM, Sidner RA, Milgrom ML. Post-transplant diabetes mellitus. The role of immunosuppression. Drug Safety 1997; 16: 242–257.PubMedCrossRefGoogle Scholar
  51. 51.
    Boudreaux JP, McHugh L, Canafax DM, et al. The impact of cyclosporine and combination immunosuppression on the incidence of posttransplant diabetes in renal allograft recipients. Transplantation 1987; 44: 376–381.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Raouf E. Nakhleh

There are no affiliations available

Personalised recommendations