Pancreas Transplantation: The Histologic Morphology of Graft Loss and Clinical Correlations

Drachenberg, Cinthia B.; Farney, Alan C.; Wiland, Anne; Blahut, Steven A.; Fink, Jeffrey C.; Philosophe, Benjamin; Schweitzer, Eugene J.; Lal, Tamay; Anderson, Lloyd L.; Bartlett, Stephen T.

doi:10.1097/00007890-200106270-00014

Cited by 112 publications

(72 citation statements)

References 33 publications

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“…The profound reduction in islet mass in this model has been found to be independent of the suggests that adequate oxygenation is key for islet function and survival (22). Unfortunately, in islet transplantransplantation site (intraportal, subrenal capsular, or intrasplenic), suggesting that islets are inherently prone to tation there is no way to maintain islet oxygenation and perfusion at preisolation levels, because the current techposttransplant apoptosis (13).…”

Section: Introductionmentioning

confidence: 94%

Factors Influencing the Loss of β-Cell Mass in Islet Transplantation

2007

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Recent advances in clinical islet transplantation have clearly demonstrated that this procedure can provide excellent glycemic control and often insulin independence in a population of patients with type 1 diabetes. A key limitation in the widespread application of clinical islet transplantation is the requirement of 10,000 islet equivalents/kg in most recipients, generally derived from two or more cadaveric donors. It has been determined that a majority of the transplanted islets fail to engraft and become fully functional. In this review article, the factors that contribute to this early loss of islets following transplantation are discussed in depth.

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Section: Introductionmentioning

confidence: 94%

Factors Influencing the Loss of β-Cell Mass in Islet Transplantation

2007

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“…MHC disparities in general, and specifically class II alloantibodies, have been associated with an increased risk of pancreas allograft loss (28). Antibody-mediated rejection has become increasingly recognized in pancreas transplantation (29) (Figure 5). Significant and/or persistent acinar damage and chronic vascular injury (transplant arteriopathy) trigger a progressive fibrogenic reaction, which eventually impairs endocrine function ( Figure 6).…”

Section: Introductionmentioning

confidence: 99%

Banff Schema for Grading Pancreas Allograft Rejection: Working Proposal by a Multi-Disciplinary International Consensus Panel

Drachenberg

Odorico

Demetris

et al. 2008

American Journal of Transplantation

158

101

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Accurate diagnosis and grading of rejection and other pathological processes are of paramount importance to guide therapeutic interventions in patients with pancreas allograft dysfunction. A multi-disciplinary panel of pathologists, surgeons and nephrologists was convened for the purpose of developing a consensus document delineating the histopathological features for diagnosis and grading of rejection in pancreas transplant biopsies. Based on the available published data and the collective experience, criteria for the diagnosis of acute cell-mediated allograft rejection (ACMR) were established. Three severity grades (I/mild, II/moderate and III/severe) were defined based on lesions known to be more or less responsive to treatment and associated with better-or worse-graft outcomes, respectively. The features of chronic rejection/graft sclerosis were reassessed, and three histological stages were established. Tentative criteria for the diagnosis of antibody-mediated rejection were also characterized, in anticipation of future studies that ought to provide more information on this process. Criteria for needle core biopsy adequacy and guidelines for pathology reporting were also defined.The availability of a simple, reproducible, clinically relevant and internationally accepted schema for grading rejection should improve the level of diagnostic accuracy and facilitate communication between all parties involved in the care of pancreas transplant recipients. 1237Drachenberg et al.

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“…A sobrevida do enxerto pancreático após o TSPR é influenciada por fatores relacionados ao tempo de transplante, de modo que a perda do enxerto pancreá-tico nas primeiras 24 horas até a primeira semana é secundária à trombose de causa técnica e à rejeição aguda, enquanto as perdas após a primeira semana até o primeiro mês são secundárias àquelas duas causas e também à infecção (32). Após o primeiro mês, as perdas por rejeição aguda e crônica predominam, porquanto após o sexto mês a principal causa de perda do enxerto pancreático é a rejeição crônica, que é classificada também pela análise semiquantitativa da fibrose do parên-quima do enxerto pancreático e tem correlação positiva com a sobrevida dele (32).…”

Section: Transplante De Pâncreas E Ilhotas No Dmunclassified

“…Após o primeiro mês, as perdas por rejeição aguda e crônica predominam, porquanto após o sexto mês a principal causa de perda do enxerto pancreático é a rejeição crônica, que é classificada também pela análise semiquantitativa da fibrose do parên-quima do enxerto pancreático e tem correlação positiva com a sobrevida dele (32).…”

Section: Transplante De Pâncreas E Ilhotas No Dmunclassified

Transplante de pâncreas e ilhotas em portadores de diabetes melito

Sá

Gonzalez

Melaragno

et al. 2008

Arq Bras Endocrinol Metab

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O transplante simultâneo de pâncreas/rim tem indicações específicas, riscos e benefícios. O procedimento, cada vez mais realizado, traz vantagens se comparado ao paciente em diálise, em relação à qualidade de vida, anos de vida ganhos e evolução das complicações crônicas. Se o paciente tiver a opção de realizar o transplante de rim com doador vivo, que apresenta sobrevida semelhante do enxerto e do paciente aos dez anos, o procedimento deverá ser considerado. O transplante de pâncreas após rim, quando efetivo, pode melhorar a evolução das complicações cardiovasculares, mas em contrapartida provoca maior mortalidade nos primeiros meses após a cirurgia. O transplante isolado de pâncreas também ocasiona a maior mortalidade pós-operatória, resultado da complexidade do procedimento e da imunossupressão. O transplante de ilhotas tem sua indicação para um seleto grupo de diabéticos com instabilidade glicêmica.

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Pancreas Transplantation: The Histologic Morphology of Graft Loss and Clinical Correlations

Cited by 112 publications

References 33 publications

Factors Influencing the Loss of β-Cell Mass in Islet Transplantation

Factors Influencing the Loss of β-Cell Mass in Islet Transplantation

Banff Schema for Grading Pancreas Allograft Rejection: Working Proposal by a Multi-Disciplinary International Consensus Panel

Transplante de pâncreas e ilhotas em portadores de diabetes melito

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