Graft dysfunction in pancreas and islet transplantation: morphological aspects

Area of Science:

• Transplantation immunology
• Endocrinology
• Pathology

Background:

• β-Cell replacement therapies, including whole pancreas transplantation (WPnTx) and islet transplantation, seek to achieve long-term insulin independence for diabetic patients.
• Despite advances, challenges remain in minimizing side-effects and complications associated with these interventions.

Purpose of the Study:

• To review the current understanding of morphological features of antibody-mediated rejection in WPnTx.
• To summarize the clinical and morphological aspects of posttransplant diabetes mellitus (PTDM), including recurrent autoimmune diabetes mellitus.
• To briefly discuss histopathological data related to islet transplantation.

Main Methods:

• Review of recent literature on histopathology and diagnostic modalities in solid organ transplantation, specifically WPnTx.
• Focus on morphological features of allograft rejection, particularly antibody-mediated rejection.
• Analysis of data concerning the incidence and mechanisms of PTDM.

Main Results:

• Standardization efforts in WPnTx have led to categorization of morphological features of allograft rejection.
• Antibody-mediated rejection is a significant factor impacting both short and long-term graft survival in WPnTx.
• Posttransplant diabetes mellitus (PTDM) occurs with high incidence following WPnTx, necessitating further understanding of its mechanisms.

Conclusions:

• Understanding the morphological characteristics of antibody-mediated rejection and PTDM is crucial for improving WPnTx outcomes.
• Further research into PTDM mechanisms is essential for developing preventive and therapeutic strategies.
• Histopathological insights into islet transplantation are also being considered in the context of β-cell replacement.