Einstein (São Paulo) (Sep 2008)
Acute antibody-mediated rejection after pancreas transplantation
Abstract
Objective: Acute antibody-mediated rejection requires specific treatment and has a negative impact on graft survival. The objectives were to report the incidence of antibody-mediated rejection after pancreas transplantation, the demographic data, the outcome and the pattern of C4d distribution, as well as the correlation with laboratory data. Methods: Optical microscopy, immunofluorescence for C4d staining and donor-specific antibody search by Luminex® in 31 kidney biopsies in 17 patients (median 87 days) and 34 pancreas biopsies in 22 patients (median 192 days), from August 2006 to August 2008. The following tests were performed: χ2, t-Student, Pearson´s correlation coefficient and logistic regression (p < 0.05). Rresults: Forty-seven percent of acute pancreas rejections were of humoral type: five acute; two subclinical and one silent. Before and after treatment of acute rejection (n = 17, 65% of biopsies): amylasuria 1271.3 ± 1214.1 versus 1966.5 ± 1423 U/h (p = 0.004); amylase 188.4 ± 87.9 versus 102.3 ± 47.2 U/l (p < 0.0001) and lipase 1219.1 ± 594.4 versus 419.3 ± 207.3 U/L (p < 0.0001), respectively. There was correlation between acute rejection diagnosis and amylase (p = 0.02) and lipase (p = 0.018), as well as correlation with each other (p = 0.0013, r2 =0.49). 27.3% of kidney acute rejections were of humoral type: one acute, one subclinical and one silent. There was no correlation between C4d staining and graft survivals. C4d pattern was diffuse in more than 60% of biopsies. Cconclusions: antibody-mediated rejection after pancreas transplantation showed elevated rates, which suggests that C4d staining should be routinely investigated. Laboratory data may be a useful tool to diagnosis of acute rejection and to evaluate the response to treatment.
