Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation

M. Dong, A. K. Parsaik, Walter K Kremers, A. Sun, P. Dean, M. Prieto, Fernando G Cosio, M. J. Gandhi, Lizhi Zhang, Thomas Christopher Smyrk, Mark D Stegall, Yogish C Kudva

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

The effect of acute allograft rejection (AR) on long-term pancreas allograft function is unclear. We retrospectively studied 227 consecutive pancreas transplants performed at our institution between January 1, 998 and December 31, 2009 including: 56 simultaneous pancreas and kidney (SPK), 69 pancreas transplantation alone (PTA); and 102 pancreas after kidney (PAK) transplants. With a median follow-up of 6.1 (IQR 3-9) years, 57 patients developed 79 episodes of AR, and 19 experienced more than one episode. The cumulative incidence for AR was 14.7%, 19.7%, 26.6% and 29.1% at 1, 2, 5 and 10 years. PTA transplant (hazards ratio [HR] = 2.28, p = 0.001) and donor age (per 10 years) (HR = 1.34, p = 0.006) were associated with higher risk for AR. The first AR episode after 3 months post PT was associated with increased risk for complete loss (CL) (HR 3.79, p < 0.001), and the first AR episode occurring during 3- to 12-month and 12- to 24-month periods after PT were associated with significantly increased risk for at least partial loss (PL) (HR 2.84, p = 0.014; and HR 6.25, p < 0.001, respectively). We conclude that AR is associated with increased risk for CL and at least PL. The time that the first AR is observed may influence subsequent graft failure.

Original languageEnglish (US)
Pages (from-to)1019-1025
Number of pages7
JournalAmerican Journal of Transplantation
Volume13
Issue number4
DOIs
StatePublished - Apr 2013

Fingerprint

Pancreas Transplantation
Allografts
Pancreas
Transplants
Kidney
Tissue Donors

Keywords

  • Acute rejection
  • complete graft loss
  • pancreas transplantation
  • partial graft loss

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation. / Dong, M.; Parsaik, A. K.; Kremers, Walter K; Sun, A.; Dean, P.; Prieto, M.; Cosio, Fernando G; Gandhi, M. J.; Zhang, Lizhi; Smyrk, Thomas Christopher; Stegall, Mark D; Kudva, Yogish C.

In: American Journal of Transplantation, Vol. 13, No. 4, 04.2013, p. 1019-1025.

Research output: Contribution to journalArticle

Dong, M. ; Parsaik, A. K. ; Kremers, Walter K ; Sun, A. ; Dean, P. ; Prieto, M. ; Cosio, Fernando G ; Gandhi, M. J. ; Zhang, Lizhi ; Smyrk, Thomas Christopher ; Stegall, Mark D ; Kudva, Yogish C. / Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation. In: American Journal of Transplantation. 2013 ; Vol. 13, No. 4. pp. 1019-1025.
@article{a66bd1d6899a4f0799cd106d679d3957,
title = "Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation",
abstract = "The effect of acute allograft rejection (AR) on long-term pancreas allograft function is unclear. We retrospectively studied 227 consecutive pancreas transplants performed at our institution between January 1, 998 and December 31, 2009 including: 56 simultaneous pancreas and kidney (SPK), 69 pancreas transplantation alone (PTA); and 102 pancreas after kidney (PAK) transplants. With a median follow-up of 6.1 (IQR 3-9) years, 57 patients developed 79 episodes of AR, and 19 experienced more than one episode. The cumulative incidence for AR was 14.7{\%}, 19.7{\%}, 26.6{\%} and 29.1{\%} at 1, 2, 5 and 10 years. PTA transplant (hazards ratio [HR] = 2.28, p = 0.001) and donor age (per 10 years) (HR = 1.34, p = 0.006) were associated with higher risk for AR. The first AR episode after 3 months post PT was associated with increased risk for complete loss (CL) (HR 3.79, p < 0.001), and the first AR episode occurring during 3- to 12-month and 12- to 24-month periods after PT were associated with significantly increased risk for at least partial loss (PL) (HR 2.84, p = 0.014; and HR 6.25, p < 0.001, respectively). We conclude that AR is associated with increased risk for CL and at least PL. The time that the first AR is observed may influence subsequent graft failure.",
keywords = "Acute rejection, complete graft loss, pancreas transplantation, partial graft loss",
author = "M. Dong and Parsaik, {A. K.} and Kremers, {Walter K} and A. Sun and P. Dean and M. Prieto and Cosio, {Fernando G} and Gandhi, {M. J.} and Lizhi Zhang and Smyrk, {Thomas Christopher} and Stegall, {Mark D} and Kudva, {Yogish C}",
year = "2013",
month = "4",
doi = "10.1111/ajt.12167",
language = "English (US)",
volume = "13",
pages = "1019--1025",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Acute pancreas allograft rejection is associated with increased risk of graft failure in pancreas transplantation

AU - Dong, M.

AU - Parsaik, A. K.

AU - Kremers, Walter K

AU - Sun, A.

AU - Dean, P.

AU - Prieto, M.

AU - Cosio, Fernando G

AU - Gandhi, M. J.

AU - Zhang, Lizhi

AU - Smyrk, Thomas Christopher

AU - Stegall, Mark D

AU - Kudva, Yogish C

PY - 2013/4

Y1 - 2013/4

N2 - The effect of acute allograft rejection (AR) on long-term pancreas allograft function is unclear. We retrospectively studied 227 consecutive pancreas transplants performed at our institution between January 1, 998 and December 31, 2009 including: 56 simultaneous pancreas and kidney (SPK), 69 pancreas transplantation alone (PTA); and 102 pancreas after kidney (PAK) transplants. With a median follow-up of 6.1 (IQR 3-9) years, 57 patients developed 79 episodes of AR, and 19 experienced more than one episode. The cumulative incidence for AR was 14.7%, 19.7%, 26.6% and 29.1% at 1, 2, 5 and 10 years. PTA transplant (hazards ratio [HR] = 2.28, p = 0.001) and donor age (per 10 years) (HR = 1.34, p = 0.006) were associated with higher risk for AR. The first AR episode after 3 months post PT was associated with increased risk for complete loss (CL) (HR 3.79, p < 0.001), and the first AR episode occurring during 3- to 12-month and 12- to 24-month periods after PT were associated with significantly increased risk for at least partial loss (PL) (HR 2.84, p = 0.014; and HR 6.25, p < 0.001, respectively). We conclude that AR is associated with increased risk for CL and at least PL. The time that the first AR is observed may influence subsequent graft failure.

AB - The effect of acute allograft rejection (AR) on long-term pancreas allograft function is unclear. We retrospectively studied 227 consecutive pancreas transplants performed at our institution between January 1, 998 and December 31, 2009 including: 56 simultaneous pancreas and kidney (SPK), 69 pancreas transplantation alone (PTA); and 102 pancreas after kidney (PAK) transplants. With a median follow-up of 6.1 (IQR 3-9) years, 57 patients developed 79 episodes of AR, and 19 experienced more than one episode. The cumulative incidence for AR was 14.7%, 19.7%, 26.6% and 29.1% at 1, 2, 5 and 10 years. PTA transplant (hazards ratio [HR] = 2.28, p = 0.001) and donor age (per 10 years) (HR = 1.34, p = 0.006) were associated with higher risk for AR. The first AR episode after 3 months post PT was associated with increased risk for complete loss (CL) (HR 3.79, p < 0.001), and the first AR episode occurring during 3- to 12-month and 12- to 24-month periods after PT were associated with significantly increased risk for at least partial loss (PL) (HR 2.84, p = 0.014; and HR 6.25, p < 0.001, respectively). We conclude that AR is associated with increased risk for CL and at least PL. The time that the first AR is observed may influence subsequent graft failure.

KW - Acute rejection

KW - complete graft loss

KW - pancreas transplantation

KW - partial graft loss

UR - http://www.scopus.com/inward/record.url?scp=84875717231&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875717231&partnerID=8YFLogxK

U2 - 10.1111/ajt.12167

DO - 10.1111/ajt.12167

M3 - Article

C2 - 23432918

AN - SCOPUS:84875717231

VL - 13

SP - 1019

EP - 1025

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 4

ER -