Histopathology of pancreas transplantation
This presentation is the property of its rightful owner.
Sponsored Links
1 / 36

HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION PowerPoint PPT Presentation


  • 79 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

HISTOPATHOLOGY OF PANCREAS TRANSPLANTATION

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


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)


Histopathology of pancreas transplantation

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

IMinimal septal inflammation

IIVenous endotheliitis

IIIAcinar inflammation

IVArterial endotheliitis/ transmural arteritis

VParenchymal 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


Histopathology of pancreas transplantation

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


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 01529

Ac Rej Grade I98

Ac Rej Grade II128

Ac Rej Grade III4428

Ac Rej Grade IV73

Ac Rej Grade V50

Total Acute Rej68% 39%


Histopathology of pancreas transplantation

March 2002

April 2002

May 2002


Histopathology of pancreas transplantation

(Papadimitriou et al.: AJT May 2003)


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


Histopathology of pancreas transplantation

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 I314

Ch Rej Grade II15

Ch Rej Grade III04

Total Chronic Rej4% 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.


  • Login