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Antibody‐Mediated Rejection of a Pancreas Allograft
Author(s) -
Melcher M.L.,
Olson J.L.,
BaxterLowe L.A.,
Stock P.G.,
Posselt A.M.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.01185.x
Subject(s) - medicine , pancreas transplantation , plasmapheresis , pancreas , rituximab , transplantation , isoantibodies , antibody , biopsy , flow cytometry , pathology , urology , kidney transplantation , gastroenterology , immunology
The role of antibody‐mediated rejection (AMR) in pancreas transplantation is poorly understood. Here, we report on a patient who developed AMR of his pancreas allograft after receiving a simultaneous pancreas‐kidney transplant. Pre‐operative enhanced cytotoxicity and flow cytometry T‐cell crossmatches were negative; B‐cell crossmatches were not performed as per institutional protocol. The patient's post‐operative course was significant for elevated serum amylase levels and development of hyperglycemia approximately 1 month after transplantation. A pancreatic biopsy at this time showed no cellular infiltrate but strong immunofluorescent staining for C4d in the interacinar capillaries. Analysis of the patient's serum identified donor‐specific HLA‐DR alloantibodies. He received intravenous immunoglobulin (IVIg), rituximab and plasmapheresis, and his pancreatic function normalized. We conclude that clinically significant AMR can develop in a pancreas allograft and recommend that pancreatic biopsies be assessed for C4d deposition if the patient has risk factors for AMR and/or the pathologic evidence for cell‐mediated rejection is underwhelming.