HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION

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HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION

• Cinthia B. Drachenberg, M.D.
• University of Maryland
• School of Medicine

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PANCREAS TRANSPLANTATION

• 19,000, October 2002 (IPTR)

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PANCREAS TRANSPLANTATION
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PANCREAS TRANSPLANTATION

• Graft survival rates continue to improve
• Simultaneous pancreas-kidney 85
• Pancreas after kidney 77
• Pancreas transplant alone 73
• Patient survival at one year gt94

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HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION

• 12 years since the first percutaneous biopsies
  were performed (Allen et al. Transplantation
  199151 1213).
• ?1000 pancreas transplant bx at the Univ. of
  Maryland since 1992

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Experimental models of acute pancreas allograft
rejection

• SEPTAL INFLAMMATION
• VENOUS ENDOTHELIITIS AND INFLAMMATION OF DUCTS
• ACINAR INFLAMMATION
• INFLAMMATION OF ARTERIAL BRANCHES
• Allen et al Am J Pathol 1991,138303
• Schulak et al Surgery 1995,98330.
• Steineger et al Am J Pathol 1986,124253.
• Carpenter et al Transplantation 1989,48764.

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GRADING ACUTE REJECTION

• 0 No inflammation
• I Minimal septal inflammation
• II Venous endotheliitis
• III Acinar inflammation
• IV Arterial endotheliitis/ transmural
  arteritis
• V Parenchymal necrosis
• (Drachenberg et al. Transplantation
  1997631579-86)

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PANCREAS TRANSPLANT NEEDLE BIOPSY

• Minimum tissue amount adequate for diagnosis in a
  needle biopsy
• Two lobules with associated septal tissue
  (arteries,veins, ducts).
• HE stained sections x3
• Massons trichrome stain
• Unstained slides

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Rates in graft loss due to rejection by era (IPTR)
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Comparison between the first 100 and the last 100
biopsies

• First 100 Last 100
• Ac Rej Grade 0 15 29
• Ac Rej Grade I 9 8
• Ac Rej Grade II 12 8
• Ac Rej Grade III 44 28
• Ac Rej Grade IV 7 3
• Ac Rej Grade V 5 0
• Total Acute Rej 68 39

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March 2002
April 2002
May 2002
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(Papadimitriou et al. AJT
May 2003)
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PANCREAS TRANSPLANTS GRADING OF CHRONIC
REJECTION/GRAFT SCLEROSIS

• Chronic rejection Grade 0
• Normal septa

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PANCREAS TRANSPLANTS GRADING OF CHRONIC
REJECTION/GRAFT SCLEROSIS

• Chronic rejection Grade I
• Fibrosis in lt30 of core
• Center of the lobules intact

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PANCREAS TRANSPLANTS GRADING OF CHRONIC
REJECTION/GRAFT SCLEROSIS

• Chronic rejection Grade II
• Fibrosis in 30-60 of core
• Center of the lobules
• shows fibrosis

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PANCREAS TRANSPLANTS GRADING OF CHRONIC
REJECTION/GRAFT SCLEROSIS

• Chronic rejection Grade III
• Extensive fibrosis in gt60 of core
• Minimal residual parenchyma

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GRADO DE RECHAZO CRONICO EN RELACION AL
TIEMPO DESDE EL TRANSPLANTE Y EN RELACION AL
TIEMPO RESIDUAL DE FUNCION PANCREATICA
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Comparison between the first 100 and the last 100
biopsies

• First 100 Last 100
• Ch Rej Grade I 3 14
• Ch Rej Grade II 1 5
• Ch Rej Grade III 0 4
• Total Chronic Rej 4 23

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HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION

• In comparison to other solid organ transplants,
  less is known. This pathology field continues to
  evolve together with the clinical and surgical
  advances in pancreas transplantation.
• Has been a very important tool for the
  improvement of patient and graft outcomes,
  particularly in solitary pancreas
  transplantation.