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HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION. Cinthia B. Drachenberg, M.D. University of Maryland School of Medicine. PANCREAS TRANSPLANTATION. 19,000, October 2002 (IPTR). PANCREAS TRANSPLANTATION. PANCREAS TRANSPLANTATION. Graft survival rates continue to improve

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histopathology of pancreas transplantation

HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION

Cinthia B. Drachenberg, M.D.

University of Maryland

School of Medicine

pancreas transplantation
PANCREAS TRANSPLANTATION
  • 19,000, October 2002 (IPTR)
slide3

PANCREAS

TRANSPLANTATION

pancreas transplantation1
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%
histopathology of pancreas transplantation1
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
experimental models of acute pancreas allograft rejection
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.

grading acute rejection
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;63:1579-86)

pancreas transplant needle biopsy
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
comparison between the first 100 and the last 100 biopsies
Comparison between the first 100 and the last 100 biopsies

First 100Last 100

Ac Rej Grade 0 15 29

Ac Rej Grade I 9 8

Ac Rej Grade II 12 8

Ac Rej Grade III 44 28

Ac Rej Grade IV 7 3

Ac Rej Grade V 5 0

Total Acute Rej 68% 39%

slide28

March 2002

April 2002

May 2002

pancreas transplants grading of chronic rejection graft sclerosis
PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
  • Chronic rejection Grade 0
  • Normal septa
pancreas transplants grading of chronic rejection graft sclerosis1
PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
  • Chronic rejection Grade I
  • Fibrosis in <30% of core
  • Center of the lobules intact
pancreas transplants grading of chronic rejection graft sclerosis2
PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
  • Chronic rejection Grade II
  • Fibrosis in 30-60% of core
  • Center of the lobules

shows fibrosis

pancreas transplants grading of chronic rejection graft sclerosis3
PANCREAS TRANSPLANTS: GRADING OF CHRONIC REJECTION/GRAFT SCLEROSIS
  • Chronic rejection Grade III
  • Extensive fibrosis in >60% of core
  • Minimal residual parenchyma
slide34

GRADO DE RECHAZO CRONICO EN RELACION AL TIEMPO

DESDE EL TRANSPLANTE Y EN RELACION AL TIEMPO

RESIDUAL DE FUNCION PANCREATICA

comparison between the first 100 and the last 100 biopsies1
Comparison between the first 100 and the last 100 biopsies

First 100Last 100

Ch Rej Grade I 3 14

Ch Rej Grade II 1 5

Ch Rej Grade III 0 4

Total Chronic Rej 4% 23%

histopathology of pancreas transplantation2
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.
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