Introduction: Hyperglycemia is usually considered a late sign in pancreas rejection, often times correlating with high grades of rejection and low rates of graft recovery. At our center, pancreas dysfunction is an indication for simultaneous kidney and pancreas biopsies. The purpose of this study is to report the prevalence, grades and types of pancreas rejection in this setting, and the response to anti-rejection treatment.
Methods: From Janurary, 2013 to December, 2019 we have performed 41 pancreas biopsies in patients with hyperglycemia. 26 had acute rejection (63%). Non-acute rejection cases were reported as normal findings (4), PTDM (4), CNI toxicity (3), severe chronic damage (3), and 1 suspected recurrence of autoimmunity. Acute rejection cases were 11 TCMR grade 1, 9 TCMR grade 2, 3 AMR and 3 mixed rejections. After anti-rejection treatment, 10 patients were discharged with no insulin requirements. Among them, 4 had recurrent rejection at a mean time of 24 months and 2 patients loss their grafts. On the other hand, 16 patients were on insulin after anti-rejection treatment. Among them 6 patients never recovered pancreas function and lost their grafts. In contrast, 4 patients recovered pancreas function although continue to require small amounts of insulin (less than 50% of pre transplant requirements). Finally, there were 6 cases in which patients became off-insulin at a mean time of 2.4 months after treatment (0.3-3.8 months). Among these patients 2 developed recurrent rejection and lost their grafts at a mean time of 13 months of follow-up.
Conclusions: Hyperglycemia after pancreas transplantation is associated with pancreas graft rejection in about 2/3 of the cases, and can be present in a variety of grades and types of rejection. With anti-rejection treatment more than 58% of the patients can recover pancreas graft function. It may take several weeks for some patients to became off-insulin.