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Pancreas transplant rejection

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https://www.readbyqxmd.com/read/29317301/antibody-mediated-rejection-due-to-de-novo-dsa-causing-venous-thrombosis-of-pancreas-allograft-a-case-report
#1
Kunal Yadav, Adrian Cotterell, Pamela Kimball, Laura Warmke, Melissa Contos, Gaurav Gupta, Anne King, Dhiren Kumar, Marlon Levy
This case describes a 34year old female who underwent an HLA identical living donor kidney transplant with a positive flow cytometric crossmatch (FCXM), but without any donor specific antibody (DSA). Tests to detect non-HLA antibody and autoantibody were negative. Allograft functioned well without rejection. She later received a pancreas allograft, again with a weakly positive FCXM, without DSA. After good initial graft function, she developed hyperglycemia six weeks posttransplant. Cross-sectional imaging demonstrated non-enhancing pancreas allograft with new vein thrombosis...
January 6, 2018: Transplant Immunology
https://www.readbyqxmd.com/read/29316221/pancreas-transplant-rejection-episodes-are-not-revealed-by-biopsies-of-the-donor-duodenum-in-a-prospective-study-with-paired-biopsies
#2
E Nordheim, R Horneland, E M Aandahl, K Grzyb, L Aabakken, V Paulsen, K Midtvedt, A Hartmann, T Jenssen
The surgical technique with duodeno- duodenal enteroanastomosis of pancreas transplants allows for representative endoscopic ultrasound guided needle biopsies of the donor duodenum and the pancreas graft. We assessed whether histological findings in transplanted donor duodenal biopsies can indicate rejection in the transplanted pancreas. From September 2012, a duodeno-duodenal enteroanastomosis has been default technique for pancreas transplantations at our center. In 67 recipients we prospectively examined 113 endoscopic ultrasound- guided procedures with representative biopsies from the duodenum- and the pancreas grafts (97 per protocol and 16 on indication)...
January 9, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29311365/simultaneous-recognition-of-allogeneic-mhc-and-cognate-autoantigen-by-autoreactive-t-cells-in-transplant-rejection
#3
Adam L Burrack, Laurie G Landry, Janet Siebert, Marilyne Coulombe, Ronald G Gill, Maki Nakayama
The autoimmune condition is a primary obstacle to inducing tolerance in type 1 diabetes patients receiving allogeneic pancreas transplants. It is unknown how autoreactive T cells that recognize self-MHC molecules contribute to MHC-disparate allograft rejection. In this report, we show the presence and accumulation of dual-reactive, that is autoreactive and alloreactive, T cells in C3H islet allografts that were transplanted into autoimmune diabetic NOD mice. Using high-throughput sequencing, we discovered that T cells prevalent in allografts share identical TCRs with autoreactive T cells present in pancreatic islets...
January 8, 2018: Journal of Immunology: Official Journal of the American Association of Immunologists
https://www.readbyqxmd.com/read/29288549/transplantation-of-macro-encapsulated-human-islets-within-the-bioartificial-pancreas-%C3%AE-air-to-patients-with-type-1-diabetes-mellitus
#4
Per-Ola Carlsson, Daniel Espes, Amir Sedigh, Avi Rotem, Baruch Zimermann, Helena Grinberg, Tali Goldman, Uriel Barkai, Yuval Avni, Gunilla T Westermark, Lina Carlbom, Håkan Ahlström, Olof Eriksson, Johan Olerud, Olle Korsgren
Macroencapsulation devices provide the dual possibility to immunoprotect transplanted cells while also being retrievable; the latter bearing importance for safety in future trials with stem-cell derived cells. However, macroencapsulation entails a problem with oxygen supply to the encapsulated cells. The βAir device solves this with an incorporated refillable oxygen tank. This phase 1 study evaluated the safety and efficacy of implanting the βAir device containing allogeneic human pancreatic islets to patients with type 1 diabetes...
December 29, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/29276781/recent-progress-in-the-use-and-tracking-of-transplanted-islets-as-a-personalized-treatment-for-type-1-diabetes
#5
Genaro A Paredes-Juarez, Paul de Vos, Jeff W M Bulte
Introduction: Type 1 diabetes mellitus (T1DM) is an autoimmune disease in which the pancreas produces insufficient amounts of insulin. T1DM patients require exogenous sources of insulin to maintain euglycemia. Transplantation of naked or microencapsulated pancreatic islets represents an alternative paradigm to obtain an autonomous regulation of blood glucose levels in a controlled and personalized fashion. However, once transplanted, the fate of these personalized cellular therapeutics is largely unknown, justifying the development of non-invasive tracking techniques...
2017: Expert Review of Precision Medicine and Drug Development
https://www.readbyqxmd.com/read/29259578/t-cell-mediated-beta-cell-destruction-autoimmunity-and-alloimmunity-in-the-context-of-type-1-diabetes
#6
REVIEW
Adam L Burrack, Tijana Martinov, Brian T Fife
Type 1 diabetes (T1D) results from destruction of pancreatic beta cells by T cells of the immune system. Despite improvements in insulin analogs and continuous blood glucose level monitoring, there is no cure for T1D, and some individuals develop life-threatening complications. Pancreas and islet transplantation have been attractive therapeutic approaches; however, transplants containing insulin-producing cells are vulnerable to both recurrent autoimmunity and conventional allograft rejection. Current immune suppression treatments subdue the immune system, but not without complications...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/29210770/in-vitro-generation-of-glucose-responsive-insulin-secreting-cells-from-pancreatic-and-duodenal-homeobox-1-overexpressing-human-induced-pluripotent-stem-cell-derived-from-diabetic-patient
#7
Bahareh Rajaei, Mehdi Shamsara, Mohammad Hossein Sanati
Pancreatic and duodenal homeobox 1 (PDX1), a member of the homeodomain-containing transcription factor family, is a key transcription factor for pancreas development and mature β-cell function. In this study, induced overexpression of PDX1 resulted in producing susceptible cells for pancreatic differentiation and was well beneficial to enhance β-cell production, maturation, function, and survival. Induced PDX1 overexpression in harmony with a set of signaling molecules involves in guiding the signaling pathways toward pancreas development, leaded to high-efficient in vitro generation of ectopic insulin-producing cells (IPCs) with the effectively reduced number of polyhormonal cells and increased number of INS single-positive cells...
November 27, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29198667/donation-after-circulatory-arrest-in-pancreas-transplantation-a-report-of-10-cases
#8
J A Fridell, R S Mangus, C M Thomas, C A Kubal, J A Powelson
INTRODUCTION: Transplantation of pancreas allografts procured from donation after circulatory death (DCD) remains uncommon. This study reviews a series of pancreas transplants at a single center to assess the donor and recipient characteristics for DCD pancreas transplant and to compare clinical outcomes. METHODS: DCD procurement was performed with a 5-minute wait time from pronouncement of death to first incision. In 2 patients, tissue plasminogen activator was infused as a thrombolytic during the donor flush...
December 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29194971/the-causes-significance-and-consequences-of-inflammatory-fibrosis-in-kidney-transplantation-the-banff-i-ifta-lesion
#9
Brian J Nankivell, Meena Shingde, Karen L Keung, Caroline L-S Fung, Richard J Borrows, Philip J O'Connell, Jeremy R Chapman
Inflammation within areas of interstitial fibrosis and tubular atrophy (i-IFTA) is associated with adverse outcomes in kidney transplantation. We evaluated i-IFTA in 429 indication- and 2052 protocol-biopsies from a longitudinal cohort of 362 kidney-pancreas recipients to determine its prevalence, time-course, and relationships with T cell mediated rejection (TCMR), immunosuppression, and outcome. Sequential histology demonstrated that i-IFTA was preceded by cellular interstitial inflammation, and followed by IF/TA...
December 1, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/29089105/simultaneous-pancreas-kidney-transplantation-experience-of-the-doce-de-octubre-hospital
#10
Carlos Jiménez-Romero, Alberto Marcacuzco Quinto, Alejandro Manrique Municio, Iago Justo Alonso, Jorge Calvo Pulido, Félix Cambra Molero, Óscar Caso Maestro, Álvaro García-Sesma, Enrique Moreno González
INTRODUCTION: Simultaneous pancreas-kidney transplantation (SPKT) constitutes the therapy of choice for diabetes type1 or type2 associated with end-stage renal disease, because is the only proven method to restore normo-glicemic control in the diabetic patient. METHODS: Retrospective and descriptive study of a series of 175 patients who underwent SPKT from March 1995 to April 2016. We analyze donor and recipient characteristics, perioperative variables and immunosuppression, post-transplant morbi-mortality, patient and graft survival, and risk factors related with patient and graft survival...
October 28, 2017: Cirugía Española
https://www.readbyqxmd.com/read/28970466/induction-of-artificial-pancreas-in-liver-transplant-recipients-preliminary-experience-with-an-insightful-message
#11
Hironori Hayashi, Hiroyuki Takamura, Ryosuke Gabata, Isamu Makino, Yoshinao Ohbatake, Shinichi Nakanuma, Tomoharu Miyashita, Hidehiro Tajima, Kazuhiro Hanazaki, Tetsuo Ohta
BACKGROUND We investigated the impact of using an artificial pancreas for glycemic control in liver transplant recipients. MATERIAL AND METHODS Between January 2014 and December 2016, glycemic control using an artificial pancreas was performed 13 times. The target blood glucose level was set at 80-110 mg/dL. We retrospectively analyzed the clinical course, including achievement rate of the target blood glucose range. RESULTS For perioperative glycemic control, an artificial pancreas was used 9 times. The total insulin dose and achievement rate of the target blood glucose level were 113...
October 3, 2017: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/28918589/isolated-pancreas-rejections-do-not-have-an-adverse-impact-on-kidney-graft-survival-whereas-kidney-rejections-are-associated-with-adverse-pancreas-graft-survival%C3%A2-in-simultaneous-pancreas-kidney-transplantation
#12
Irfan Moinuddin, Muhammad Sohail Yaqub, Tim Taber, John Powelson, Jonathan Fridell, Asif Sharfuddin
BACKGROUND AND OBJECTIVES: Diabetic Kidney Disease is associated with excessive mortality and morbidity. Simultaneous pancreas kidney transplantation (SPK) significantly improves quality of life and increases life expectancy of uremic diabetic patients. It is not known whether pancreas and kidney rejections in these transplant patients is concordant or discordant. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We analyzed clinical data on all SPK transplants performed between 2003 and 2014 at Indiana University to assess the impact of isolated or combined pancreas and kidney rejections on patient and allograft outcomes...
September 16, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28856244/design-and-methods-of-the-korean-organ-transplantation-registry
#13
Jaeseok Yang, Jong Cheol Jeong, Joongyub Lee, Young Hoon Kim, Hyo Chae Paik, Jae-Joong Kim, Hyun-Young Park, Myoung Soo Kim, Curie Ahn
BACKGROUND: Beneficial aspects of solid organ transplantation, which encompass survival benefit, improved quality of life, and cost efficacy, have been clearly demonstrated. However, regional and ethnic differences require further studies to identify prognostic factors and transplant outcomes against various backgrounds. After previous efforts of a nationwide, retrospective study on the kidney transplant outcomes in Korea, a new prospective-designed version of the Korean Organ Transplantation Registry (KOTRY) was launched in 2014...
August 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28838458/successful-simultaneous-pancreas-kidney-re-transplantation-in-a-highly-human-leukocyte-antigen-sensitized-patient
#14
S Kykalos, A Wunsch, T Klein, R Viebahn, P Schenker
BACKGROUND: The waiting time for re-transplantation for sensitized patients is greatly prolonged, given the lack of transplants that are available for this group and additional immunologic barriers. We report the case of a successful re-transplantation in a patient with very high levels of panel reactive antibodies ([PRA] >85%). METHODS: A 45-year-old woman had repetitive rejections after simultaneous pancreas-kidney transplantation, with consequent loss of function of both transplanted organs...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28777488/discordant-rejection-in-simultaneous-pancreas-and-kidney-transplantation-true-discordance-or-analysis-artefact
#15
Michela Assalino, Karine Hadaya, Axel Andres, Thierry Berney
The article by Parajuli et al published in this issue of Transplant International is the latest, and perhaps the most convincing in a relatively small body of literature, to suggest that in a situation of simultaneous pancreas-kidney transplantation (SPK), in which both organs are from the same donor, one organ may be undergoing acute rejection independently from the other (1). The organ hierarchy in immunogeneicity and susceptibility to rejection is a long known biological phenomenon, with the liver at one end of the spectrum and the intestine the other...
August 4, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28738239/delayed-graft-duodenal-perforation-due-to-impacted-food-five-years-after-simultaneous-pancreas-kidney-transplantation-a-case-report
#16
Taizo Sakata, Hideki Katagiri, Tadao Kubota, Takashi Sakamoto, Kentaro Yoshikawa, Alan Kawarai Lefor, Cheol Woong Jung, Toru Kojima
INTRODUCTION: Pancreas transplantation is the best treatment option in selected patients with type 1 diabetes mellitus. Here we report a patient with a nonmarginal duodenal perforation five years after a simultaneous pancreas-living donor kidney transplantation (SPLKT). PRESENTATION OF CASE: A 31-year old male who underwent SPLKT five years previously presented with severe abdominal pain. He had a marginal duodenal perforation four years later, treated by primary closure and drainage...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28726153/immunological-issues-after-stem-cell-based-%C3%AE-cell-replacement
#17
REVIEW
Valeria Sordi, Silvia Pellegrini, Lorenzo Piemonti
PURPOSE OF REVIEW: Islet and pancreas transplantation prove that β cell replacement can cure the glycemic derangements in type 1 diabetes (T1D). Induced pluripotent stem cells (iPSCs) can differentiate into functional insulin-producing cells, able to restore normoglycemia in diabetic animal models. iPSCs in particular can be derived from the somatic cells of a person with T1D. This review aims to clarify if it is possible to transplant autologous iPSC-derived β cells without immunosuppression or which are the alternative approaches...
September 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28719059/pancreatic-allograft-thrombosis-suggestion-for-a-ct-grading-system-and-management-algorithm
#18
A Hakeem, J Chen, S Iype, M R Clatworthy, C J E Watson, E M Godfrey, S Upponi, K Saeb-Parsy
Pancreatic allograft thrombosis (PAT) remains the leading cause of nonimmunologic graft failure. Here, we propose a new computed tomography (CT) grading system of PAT to identify risk factors for allograft loss and outline a management algorithm by retrospective review of consecutive pancreatic transplantations between 2009 and 2014. Triple-phase CT scans were graded independently by 2 radiologists as grade 0, no thrombosis; grade 1, peripheral thrombosis; grade 2, intermediate non-occlusive thrombosis; and grade 3, central occlusive thrombosis...
July 18, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28696022/outcomes-in-pancreas-transplantation-with-exocrine-drainage-through-a-duodenoduodenostomy-versus-duodenojejunostomy
#19
J P Lindahl, R Horneland, E Nordheim, A Hartmann, E M Aandahl, K Grzyb, H Haugaa, G Kjøsen, A Åsberg, T Jenssen
Until recently, pancreas transplantation has mostly been performed with exocrine drainage via duodenojejunostomy (DJ). Since 2012, DJ was substituted with duodenoduodenostomy (DD) in our hospital, allowing endoscopic access for biopsies. This study assessed safety profiles with DD versus DJ procedures and clinical outcomes with the DD technique in pancreas transplantation. DD patients (n = 117; 62 simultaneous pancreas-kidney [SPKDD ] and 55 pancreas transplantation alone [PTADD ] with median follow-up 2...
July 11, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28672081/concurrent-biopsies-of-both-grafts-in-recipients-of-simultaneous-pancreas-and-kidney-demonstrate-high-rates-of-discordance-for-rejection-as-well-as-discordance-in-type-of-rejection-a-retrospective-study
#20
Sandesh Parajuli, Emre Arpali, Brad C Astor, Arjang Djamali, Fahad Aziz, Robert R Redfield, Hans W Sollinger, Dixon B Kaufman, Jon Odorico, Didier A Mandelbrot
It is commonly assumed that in simultaneous pancreas and kidney (SPK) recipients, rejection of the two organs is concordant. As a result, concurrent biopsies of both organs are rarely performed and there are limited histological data on how often rejection is in fact discordant. We reviewed all SPK recipients transplanted at the University of Wisconsin between January 01, 2001, and December 31, 2016, that underwent biopsy of both organs. We included all patients whose biopsies were within 30 days. If patients were treated for rejection between biopsies, they were excluded if the biopsies were more than 4 days apart...
July 3, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
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