Pancreas transplantation

Topic Completed: 1 August 2012

Revised: 31 January 2019

Copyright: (c) 2002-2019,, Inc.

PubMed Search: Pancreas transplantation[TI] free full text[sb]

Deepali Jain, M.D.
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Cite this page: Jain D. Pancreas transplantation. website. Accessed May 30th, 2020.
Whole organ transplant
  • Includes pancreas transplant alone, simultaneous pancreas and kidney transplant, pancreas after kidney transplant
  • Pancreas and kidney transplanted together to achieve better glycemic control and due to significant diabetic nephropathy
  • Indications of whole organ transplant: chronic pancreatitis
Islet transplant
  • Main indication is severe type I diabetes; also patients for whom exogenous insulin may precipitate catastrophic hypoglycemia
Clinical features
  • Early complications: graft pancreatitis, pancreatic thrombosis, endothelialitis of capillaries and venules
  • Late complications: recurrence of original disease, rejection (vasculitis, obliterative endarteritis, periductal lymphocytic infiltrate), mononuclear inflammation which preferentially destroys beta cells
  • Survival: 95% at one year posttransplant, 83% after 5 years (Rev Diabet Stud 2011;8:6)
  • Poor prognostic factors: moderate to severe acinar inflammation, acinar tissue loss, fibrosis, vascular luminal narrowing (Am J Surg Pathol 1992;16:1098)
  • Note: transplanted islets produce more glucagon than insulin
  • Adequate biopsy requires 3 lobular areas and associated interlobular septa
  • Inflammation of acini, veins, arteries, ducts; associated with acinar cell damage
  • Evaluation for arteritis is critical
  • > 75% mixed small and large T lymphocytes, fewer mature plasma cells, variable eosinophils
  • < 10% atypical cells

Acute rejection:
Microscopic (histologic) images

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Acute rejection

Chronic rejection

Banff criteria images

Differential diagnosis
  • Posttransplantation lymphoproliferative disease: distinction important since opposite treatments; nodular and expansile infiltrates, mostly atypical, plasmacytoid B cells, occasional Reed-Sternberg-like cells; involves both acini and islets; extensive infiltration of peripancreatic soft tissues is common, no involvement of arterial walls unless concurrent acute vascular rejection; EBER+ (ISH) (Hum Pathol 1998;29:569)
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