Case ReviewsAccelerated Pancreas Allograft Sclerosis Due to Allograft RejectionMunivenkatappa, Raghava MD*; Papadimitriou, John C. MD, PhD†; Drachenberg, Cinthia B. MD†Author Information From the Departments of *Surgery, and †Pathology, University of Maryland School of Medicine, Baltimore, MD. Reprints: Cinthia Drachenberg, MD, Department of Pathology, University of Maryland Hospital, NBW49 22 South Greene St, Baltimore MD 21201. E-mail: [email protected]. The authors have no funding or conflicts to declare. Pathology Case Reviews: November/December 2012 - Volume 17 - Issue 6 - p 229-235 doi: 10.1097/PCR.0b013e3182759349 Buy Metrics Abstract Evaluation of pancreas allograft biopsies is absolutely necessary to determine the cause of graft dysfunction in patients with solitary pancreas transplants. In the current era of solitary pancreas transplants with exocrine drainage to the native intestine, graft dysfunction is typically defined by increased levels of amylase and/or lipase in blood (signaling injury to the exocrine tissue) or by the development of hyperglycemia (endocrine dysfunction). Milder forms of rejection typically present with increase in pancreatic enzymes, whereas both endocrine and exocrine abnormalities are more commonly found in severe pancreatic rejection. Tissue evaluation in the patient presented here sequentially demonstrated T-cell–mediated rejection, mixed T-cell–mediated rejection/antibody-mediated rejection, and finally, advanced chronic rejection/graft sclerosis. © 2012 Lippincott Williams & Wilkins, Inc.