A. Sugitani

C. Vivas

Corry

Egidi

H.A. Gritsch

J.J. Fung

Klassen

M. Jordan

M.F. Egidi

R. Shapiro

R.J. Corry

Sollinger

Sutherland

T.E. Starzl

V. Scantlebury

English

PubMed

EGIDI, MARIA FRANCESCA

Corry, R. J.

Sugitani, A.

Shapiro, R.

Jordan, M.

Vivas, C.

Scantlebury, V.

Gritsch, H. A.

Fung, J. J.

Starzl, T. E.

Archivio della Ricerca - Università di Pisa

Enteric-drained pancreas transplants monitored by fine-needle aspiration biopsy

Crossref

Egidi, MF

Corry, RJ

Sugitani, A

Shapiro, R

Jordan, M

Vivas, C

Scantlebury, V

Gritsch, HA

Fung, JJ

Starzl, TE

Name not available

Enteric-drained pancreas transplants monitored by fine needle aspiration biopsy

D-Scholarship@Pitt

i l ; 1 Enteric-Drained Pancreas Transplants Monitored by Fine-Needle Aspiration Biopsy M.F. Egidi, R.J. Corry, A. Sugitani, R. Shapiro, M. Jordan, C. Vivas, V. Scantlebury, H.A. Gritsch, J.J. Fung, and T.E. Starzl As we previously reported1•2 documentation of pan-creas rejection remains problematic because of the lack of specific and sensitive markers. Since most pancreas transplants are performed simultaneous with a kidney, clinical dysfunction from rejection, documented by an in-crease in serum creatinine and renal-core biopsy, automat-ically leads to the treatment of both grafts. Rejections of pancreatic grafts are in some way preemptively treated by the initiation of kidney-transplant treatment. Nevertheless, in combined kidney-pancreas transplantation, an incidence of isolated pancreas rejection has been documented.3 .4 We report herein our experience in documenting rejection episodes with fine-needle aspiration biopsy (FNAB) in pancreas transplant patients. The FNAB rationale resides in the fact that the immu-noactivation phenomenon begins in the graft. where infil-trating mononuclear cells endure a transformation process into "blasts." Acute cellular rejection is defined by an accumulation of immature cells (lymphoblasts. plasma-blasts. monoblasts) that can be quantified according to established cytologic criteria. Vascular rejection is generally assigned to humoral immunity with the proliferation of mononuclcar phagocytcs and tissue macrophages. How-ever, on several occasions the cellular and humoral compo-nent of rejcction can be simultaneously detected. MATERIALS AND METHODS Between July 1994 and July 19%. a totaillf n pancreas transplants were performed at the University of Pittsburgh in rype [ diabetic patients. Sixty-two patients received a simultaneous kidney trans-plant (SPK). tive patients received a sequential pancreas'( PAK), and live patients received a solitary pancreas \ PTA). Immunosuppression consisted of taerolimus (0.05 mg;kg IV for 3 to n days followed hy 0.15 mglkg p.o. hid). azathioprine (5 mg;kg IV followed Iw 1.5 to 2.0 mg;kg p.o.), or mycophenolate mofctil (I g p.o. bid. if tolerated) and steroids. No antilymphocyte antihody infusion \ induction therapy) was emplowd. Rejection episodes WCfe trealed With methylpredmsolone holuses. OKTJ monoclonal :mtihodies were used only in four patients and A TGAM in two ,)thers. CMV prophvlaxis was no! llsed <:\ccpt in Ihe scm-positive tll ,ero-nc1,!:I!i\'c donor-reCIpient comhinatilllls \ 15 pallents lor during . ,nll· r CL'II trcalll1ent. 0041- 1 315/971$1 7.00 PII S0041-13,"5(96)00396-X 67," To avoid the high complication rate related to bladder drainage,' enteric drainage was performed in most (54) of the patients. 6 FNABs of both grafts were performed as previously described,,7 according to an established protocol and when clinically indicated. RESULTS In this series of patients there was no mortality. The kidney and pancreas survival was 95% and 86%, respectively. In the SPK group, 40 patients presented one or more rejection episodes. In the majority of cases, they were documented with FNAB. In 25 cases, FNAB evidenced rejection in both grafts, whereas in five cases, FNAB showed isolated rejection of the pancreas. One patient lost both organs from antibody-mediated rejection and another one rejected both grafts following discontinuation of immu-nosuppression because of severe systemic candida infection, Two PTA patients lost the graft (one patient because of persistent active rejection despite OKT3 treatment and one other because of reflux pancreatitis). No grafts were lost in the P AK group despite every patient-presented rejection episode, detected by FNAB without other clinical symptoms of pancreatic dysfunction. CONCLUSIONS FNAB of the pancreas transplant has been proven to be a reliable technique for monitoring rejection episodes that otherwise could have heen overlooked with the usual biochemical markers. No complications (bleeding, fistula. infections) have heen reported in our series of patients who underwent repeated FNABs. The enteric-drained patient group had significantly lower rates of surgical complications in comparison with the hladder-drained group. The fact that we could easily per-form FNAB in ~nteric-drain~d pancreata has permitted a timely uiagnosis of rejection and might have optimized the amount of immunosuppression. thus avoiding infections and further complications. From the Thomas E. Starzl Transplantation Institute, Falk Clinic, Pittsburgh. Pennsylvania. Address reprint requests to M.F. Egidi, Thomas E. Starzl Transplantation Institute, 4th Floor, Falk Clinic. 3601 Fifth Ave . Pittsburgh. PA 15213. © 1997 by ElseVier Science Inc. 655 Avenue of the Americas. New York. NY 10010 r'anSDlantatlon Proceedmgs. 29. 674--675 (1997) p FINE-NEEDLE ASPIRATION BIOPSY REFERENCES 1. Egidi MF. Shapiro R. Khanna A. ct al: Transplant Proc 27:3055. 1995 2. Egidi MF. Corry RJ: Curr Opin Organ Transplant 1:44. 1996 3. Sutherland DER. Gruessner R. Moudry-Munns K. et al: Transplant Proc 27:907. 1995 675 4. Klassen OK. Hoehn-Saric EW. Weir MR. et al: Transplanta-tion 61:974. 1996 5. Sollinger HW. Messing EM. Eckhoff DE. et at: Ann Surg 218:561. 1993 6. Corry RJ. Egidi MF. Shapiro R. et al: Transplant Proc 27:3048, 1995 7. Egidi MF: Diagn Cytopatho! 6:330, 1990 

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Enteric-drained pancreas transplants monitored by fine-needle aspiration biopsy

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