Renal allograft rejection with normal renal function in simultaneous kidney/pancreas recipients: does dissynchronous...

Area of Science:

• Nephrology
• Transplant Surgery
• Immunology

Background:

• Simultaneous kidney/pancreas transplantation is a complex procedure.
• Acute rejection episodes are a known complication.
• A subset of patients experienced rejection despite preserved renal function.

Purpose of the Study:

• To investigate the occurrence and characteristics of rejection in simultaneous kidney/pancreas transplant recipients.
• To determine if pancreatic allograft rejection can occur independently of renal allograft rejection.
• To highlight the possibility of acute rejection in the context of stable renal function.

Main Methods:

• Retrospective analysis of 147 simultaneous kidney/pancreas transplantations.
• Identification of patients with acute rejection and normal renal function.
• Monitoring of serum lipase and creatinine levels, and tacrolimus levels.
• Renal allograft biopsy indicated by rising serum lipase.

Main Results:

• Seven out of 95 patients (7.4%) with acute rejection had stable renal function.
• Treatment with steroids and increased tacrolimus led to decreased serum lipase.
• Serum creatinine levels remained stable throughout the follow-up period.
• Significant reduction in serum lipase levels post-treatment.

Conclusions:

• Dissynchronous pancreatic allograft rejection without renal allograft rejection may not be a distinct clinical entity.
• Acute rejection can manifest in simultaneous kidney/pancreas transplant recipients even with normal and stable renal function.
• Monitoring pancreatic allograft-specific markers like serum lipase is crucial.