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Am J Transplant. 2013 Apr;13(4):1019-1025. doi: 10.1111/ajt.12167. Epub 2013 Feb 22.

Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation.

Author information

1
Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
2
Department of Endocrinology and Metabolism, Qilu Hospital of Shandong University, Jinan, Shandong, P. R. China.
3
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
4
Department of Endocrinology and Metabolism, Zibo First People's Hospital, Zibo, Shandong, P. R. China.
5
Division of Transplantation Surgery, Department of Surgery.
6
Division of Nephrology and Hypertension, Department of Internal Medicine.
7
Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology.
8
Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

Abstract

The effect of acute allograft rejection (AR) on long-term pancreas allograft function is unclear. We retrospectively studied 227 consecutive pancreas transplants performed at our institution between January 1, 998 and December 31, 2009 including: 56 simultaneous pancreas and kidney (SPK), 69 pancreas transplantation alone (PTA); and 102 pancreas after kidney (PAK) transplants. With a median follow-up of 6.1 (IQR 3-9) years, 57 patients developed 79 episodes of AR, and 19 experienced more than one episode. The cumulative incidence for AR was 14.7%, 19.7%, 26.6% and 29.1% at 1, 2, 5 and 10 years. PTA transplant (hazards ratio [HR]=2.28, p=0.001) and donor age (per 10 years) (HR=1.34, p=0.006) were associated with higher risk for AR. The first AR episode after 3 months post PT was associated with increased risk for complete loss (CL) (HR 3.79, p<0.001), and the first AR episode occurring during 3- to 12-month and 12- to 24-month periods after PT were associated with significantly increased risk for at least partial loss (PL) (HR 2.84, p=0.014; and HR 6.25, p<0.001, respectively). We conclude that AR is associated with increased risk for CL and at least PL. The time that the first AR is observed may influence subsequent graft failure.

PMID:
23432918
DOI:
10.1111/ajt.12167
[Indexed for MEDLINE]
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