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

17 Scopus citations

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

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Keywords

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

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

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