Histological features of acute pancreatic allograft rejection after pancreaticoduodenal transplantation in the rat

Abstract

For characterization of histopathological changes during pancreas graft rejection, pancreaticoduodenal transplants were performed in three groups: (1) Brown Norway into diabetic Lewis rats without immunosuppression, (2) Brown Norway into diabetic Lewis rats with cyclosporin A, and (3) Lewis into Lewis rats. Diffuse inflammatory infiltration of the acini by mononuclear cells indicated the onset of rejection (stage I). Shortly after acinar infiltration, damage to small and large interlobular excretion ducts occurred. This took the form of florid circumferential inflammation and vacuolar degeneration of epithelium similar to the bile duct damage seen in primary biliary cirrhosis, graft-versus-host disease, and liver allograft rejection (stage II). Thereafter, endothelialitis and destruction of islets were evident, consistent with a more advanced and irreversible stage of rejection (stage III). Acinar inflammation and moderate duct lesions were not prevented by immunosuppression but were delayed. Nonetheless, severe vascular changes and loss of islets were avoided. We conclude that duct lesions are a reliable criterion for pancreas allograft rejection. They are more sensitive than vascular changes and more specific than cellular infiltration of acinar tissue, which may also occur in infection.

Different biopsy techniques for different pancreas graft locations after homolateral simultaneous pancreas-kidney transplantation

“…Because the recipients of the SPK transplants were all diabetic patients with stage 5 chronic kidney disease, there was no need to remove their original pancreas, and both the transplanted pancreas and the recipient’s own pancreas were simultaneously present. Clinical diagnoses are often difficult in patients with elevated serum amylase and lipase concentrations, and problems such as pancreatitis of the transplanted pancreas, rejection of the transplanted pancreas ( 6 , 7 ), and pancreatitis of the original pancreas can occur. Differential diagnoses are difficult, and biopsy of the transplanted pancreas is the gold standard for diagnosis.…”