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How Should Pancreas Transplant Rejection Be Treated?

Aziz, Fahad MD1; Parajuli, Sandesh MD1; Uddin, Salah MD1; Harrold, Kylie PA1; Djamali, Arjang MD1,2; Astor, Brad PhD1; Odorico, Jon MD2; Mandelbrot, Didier MD1

doi: 10.1097/TP.0000000000002694
Original Clinical Science—General
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Background. Limited published data exist to guide the treatment of pancreas transplant rejection.

Methods. We reviewed the treatment and outcomes of 158 first episodes of biopsy-proven pancreas rejection between 1 January 1997 and 31 December 2016. Within each Banff grade of rejection, we compared response rates and long-term outcomes with steroids alone versus steroids plus antithymocyte globulin (ATG).

Results. Of 158 pancreas recipients with rejection, 65 were treated with steroids alone. Eighty-three percent of patients with grade I, 60% with grade II, and 33.33% with grade III rejection responded to treatment with steroids alone. Ninety-three patients were treated with steroids plus ATG. The response rates were 69% in grade I, 76% in grade II, and 73% in grade III. Response rates and graft survival were not different with grade I rejection treated with steroids alone versus steroids plus ATG. However, response rates and graft survival were significantly better with grade III rejection treated with the addition of ATG, and graft survival rates were significantly better with grade II rejection treated with the addition of ATG.

Conclusions. Grade I pancreas rejection can usually be successfully treated with steroids alone, whereas grade II and III rejection should usually be treated with steroids plus ATG, as the addition of ATG improves both response rates and graft survival.

1 Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.

2 Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Received 27 October 2018. Revision received 9 February 2019.

Accepted 13 February 2019.

The authors declare no conflicts of interest.

The writing of this article was supported by an unrestricted research grant from the Virginia Lee Cook Foundation.

F.A. involved in design, data collection, analysis, and manuscript preparation. S.P., S.U., A.D., and B.A. involved in analysis and editing. K.H. involved in analysis, editing, and data collection. J.O. involved in original idea, study concept, study design, analysis, and editing. D.M. involved in original idea, study concept, study design, analysis, manuscript preparation, and editing.

Correspondence: Fahad Aziz, MD, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI 53705. (faziz@wisce.edu).

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