1. HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION
Cinthia B. Drachenberg, M.D.
University of Maryland
School of Medicine

2. PANCREAS TRANSPLANTATION
19,000, October 2002 (IPTR)

3. PANCREAS
TRANSPLANTATION

4. 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 >94%

5. HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION
12 years since the first percutaneous biopsies were performed (Allen et al. Transplantation 1991;51: 1213).
1000 pancreas transplant bx at the Univ. of Maryland since 1992

6. 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 1991,138:303
Schulak et al: Surgery 1995,98:330.
Steineger et al: Am J Pathol 1986,124:253.
Carpenter et al: Transplantation 1989,48:764.

12. 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 1997;63: )

22. PANCREAS TRANSPLANT NEEDLE BIOPSY
Minimum tissue amount adequate for diagnosis in a needle biopsy:
Two lobules with associated septal tissue (arteries,veins, ducts).
H&E stained sections x3
Masson’s trichrome stain
Unstained slides

23. Rates in graft loss due to rejection by era (IPTR)

24. Comparison between the first 100 and the last 100 biopsies
First Last 100
Ac Rej Grade
Ac Rej Grade I
Ac Rej Grade II
Ac Rej Grade III
Ac Rej Grade IV 7 3
Ac Rej Grade V
Total Acute Rej 68% 39%

28. March 2002
April 2002
May 2002

29. (Papadimitriou et al.: AJT May 2003)

30. PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
Chronic rejection Grade 0
Normal septa

31. PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
Chronic rejection Grade I
Fibrosis in <30% of core
Center of the lobules intact

32. PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
Chronic rejection Grade II
Fibrosis in 30-60% of core
Center of the lobules
shows fibrosis

33. PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
Chronic rejection Grade III
Extensive fibrosis in >60% of core
Minimal residual parenchyma

34. GRADO DE RECHAZO CRONICO EN RELACION AL TIEMPO
DESDE EL TRANSPLANTE Y EN RELACION AL TIEMPO
RESIDUAL DE FUNCION PANCREATICA

35. Comparison between the first 100 and the last 100 biopsies
First Last 100
Ch Rej Grade I
Ch Rej Grade II 1 5
Ch Rej Grade III 0 4
Total Chronic Rej 4% 23%

36. 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.