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The role of antibody-mediated rejection (AMR) in pancreas transplantation is poorly understood. Here, we report on a patient who developed AMR of his pancreas allograft after receiving a simultaneous pancreas-kidney transplant. Pre-operative enhanced cytotoxicity and flow cytometry T-cell crossmatches were negative; B-cell crossmatches were not performed as per institutional protocol. The patient's post-operative course was significant for elevated serum amylase levels and development of hyperglycemia approximately 1 month after transplantation. A pancreatic biopsy at this time showed no cellular infiltrate but strong immunofluorescent staining for C4d in the interacinar capillaries. Analysis of the patient's serum identified donor-specific HLA-DR alloantibodies. He received intravenous immunoglobulin (IVIg), rituximab and plasmapheresis, and his pancreatic function normalized. We conclude that clinically significant AMR can develop in a pancreas allograft and recommend that pancreatic biopsies be assessed for C4d deposition if the patient has risk factors for AMR and/or the pathologic evidence for cell-mediated rejection is underwhelming.
M L Melcher, and
J L Olson, and
L A Baxter-Lowe, and
P G Stock, and
A M Posselt
July 2009,
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M L Melcher, and
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A M Posselt
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M L Melcher, and
J L Olson, and
L A Baxter-Lowe, and
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A M Posselt
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M L Melcher, and
J L Olson, and
L A Baxter-Lowe, and
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M L Melcher, and
J L Olson, and
L A Baxter-Lowe, and
P G Stock, and
A M Posselt
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