of
PANCREAS ALLOGRAFTS SESSION: SUMMARY
• Jon Odorico
Pancreatic AMR – Clinicopathological
correlations and experience at Wisconsin-
Madison.
Study Design
• Single center, retrospective study of “for-cause”
pancreas
allograft biopsies
• 94 Bx from 49 patients
• 16...
Summary Acute AMR
of the Pancreas Transplant
• Acute AMR Occurs in ~10% of patients in the first year
• Risk Factors: Soli...
• Surya Seshan
Summary and Conclusions
• Routine C4d staining on all pancreas allograft
biopsies is the current practice.
• C4d staining ...
• Hanneke de Kort
Banff 2013 9
1. Biopsy data:
Leiden + Maryland
de Kort et al, 2010 AJT
Banff 2013 10
2. Tq data: Leiden
AMR negative
Suspicious for
AMR
Acute AMR
Banff 2013 11
3. Data: London
• All 17 Tq; DSA and C4d negative
• 58 bx;
– 8 Bx had no arteries sampled
– Includes PAK and...
Banff 2013 12
Conclusion
Consistency with kidney so far
For pancreas allografts intimal arteritis can
be indicative of ACM...
Immunophenotypical studies on
pancreas tx inflammation
Erika Rangel (15 bx, CD68)
John Papadimitriou (46 bx, CD3,CD20,CD68)
Discussion (Erika Rangel)
 Macrophage infiltration in pancreas graft:
 Occurs in both acute AMR and TCMR
 Is associated...
Conclusions (John Papadimitriou)
CD3 increase proportionally with grades
of ACMR, AMR and stage.
CD20 increase proportiona...
CD3 CD3
CD20 CD20
ACMR I-II
Stage I-II
*
Diagnosis of rejection in grafted duodenal
cuff
Determine if a biopsy of the grafted
duodenal cuff can be a surrogate for ...
Erik Larsson and team – Ongoing
prospective studies
Uppsala University, Sweden
•Approximately 200 samples in 50 patients
•...
Danniele Holanda – Pilot retrospective
studies on archival material of 21 pancreas
samples incidentally containing duodena...
Myriam Leon Fradejas (Malaga, Spain)
Graft failure due to deposition of islet amyloid
Under recognition of Islet
processes
• The Banff pancreas group started working
on a set of recommendations for a
diagnost...
Issues with diagnostic criteria
and grading schema
• “capillaritis”
• Vascular lesions
• etc
• Hanneke de Kort and Candice...
of
Good bye Comandatuba…
Cinthia Drachenberg Pancreas Summary Banff 2013 Meeting in Brazil
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Cinthia Drachenberg Pancreas Summary Banff 2013 Meeting in Brazil

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Pancreas summary from 12th Banff Conference on Transplant Pathology from the meeting in Comandatuba-Bahia, Brazil on August 23rd, 2013 http://cybernephrology.ualberta.ca/banff/2013

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  • 84% of biopsies had dsa data
  • Cinthia Drachenberg Pancreas Summary Banff 2013 Meeting in Brazil

    1. 1. of PANCREAS ALLOGRAFTS SESSION: SUMMARY
    2. 2. • Jon Odorico Pancreatic AMR – Clinicopathological correlations and experience at Wisconsin- Madison.
    3. 3. Study Design • Single center, retrospective study of “for-cause” pancreas allograft biopsies • 94 Bx from 49 patients • 162 Pancreas Transplants 2006-09 All biopsies had C4d staining – IHC on paraffin sections • Majority (79/94) of bx had DSA data – Luminex SAB assay Niederhaus et al. AJT, in press
    4. 4. Summary Acute AMR of the Pancreas Transplant • Acute AMR Occurs in ~10% of patients in the first year • Risk Factors: Solitary pancreas transplant, Non- primary SPK transplant, Donor/recipient race mismatch, Female recipient • Patients having AMR did not have worse graft survival than patients having AMR/ACR or ACR, but do have worse outcomes than patients having no rejection • DSA+C4d- rejection is uncommon but does occur, C4d+DSA- rejection occurs; DSA alone is not diagnostic Niederhaus et al. AJT in press
    5. 5. • Surya Seshan
    6. 6. Summary and Conclusions • Routine C4d staining on all pancreas allograft biopsies is the current practice. • C4d staining along with detectable DSA remain the best method to diagnose AbMR in pancreas transplants. • Typical morphologic findings may not be apparent in early or late AbMR cases. • Further studies to examine all aspects of C4d staining and its relationship to DSA and morphological findings in the diagnosis of AbMR is needed. • Further develop and define criteria for chronic (active) AbMR.
    7. 7. • Hanneke de Kort
    8. 8. Banff 2013 9 1. Biopsy data: Leiden + Maryland de Kort et al, 2010 AJT
    9. 9. Banff 2013 10 2. Tq data: Leiden AMR negative Suspicious for AMR Acute AMR
    10. 10. Banff 2013 11 3. Data: London • All 17 Tq; DSA and C4d negative • 58 bx; – 8 Bx had no arteries sampled – Includes PAK and PTA
    11. 11. Banff 2013 12 Conclusion Consistency with kidney so far For pancreas allografts intimal arteritis can be indicative of ACMR as well as AMR, regardless of the severity
    12. 12. Immunophenotypical studies on pancreas tx inflammation Erika Rangel (15 bx, CD68) John Papadimitriou (46 bx, CD3,CD20,CD68)
    13. 13. Discussion (Erika Rangel)  Macrophage infiltration in pancreas graft:  Occurs in both acute AMR and TCMR  Is associated with the severity of the TCMR  Has negative impact on pancreas graft survival  Does not occur in significant numbers in the later fibrosing stages
    14. 14. Conclusions (John Papadimitriou) CD3 increase proportionally with grades of ACMR, AMR and stage. CD20 increase proportionally with ACMR and AMR and stage. CD68 increase proportionally with ACMR and AMR, but not stage.
    15. 15. CD3 CD3 CD20 CD20 ACMR I-II Stage I-II *
    16. 16. Diagnosis of rejection in grafted duodenal cuff Determine if a biopsy of the grafted duodenal cuff can be a surrogate for a pancreas biopsy
    17. 17. Erik Larsson and team – Ongoing prospective studies Uppsala University, Sweden •Approximately 200 samples in 50 patients •Have used these biopsies for clinical monitoring and guidance of therapeutic decisions •Excellent graft outcomes
    18. 18. Danniele Holanda – Pilot retrospective studies on archival material of 21 pancreas samples incidentally containing duodenal tissue, to evaluate the degree of concordance of pathological findings in each pair. There was >70% full concordance in the diagnosis and grade of rejection. The rest of the sampled were discordant but the disagreement was of no more than 1 grade (i.e. indeterminate vs grade 1)
    19. 19. Myriam Leon Fradejas (Malaga, Spain) Graft failure due to deposition of islet amyloid
    20. 20. Under recognition of Islet processes • The Banff pancreas group started working on a set of recommendations for a diagnostic algorithm of late hyperglycemia in order to aid in the identification of islet pathology: recurrent autoimmune DM and islet amyloidosis. • Topic of extensive discussions on 2011 Banff meeting.
    21. 21. Issues with diagnostic criteria and grading schema • “capillaritis” • Vascular lesions • etc • Hanneke de Kort and Candice Roufosse have made a preliminary analysis of the most important issues that need attention and this will be the basis to proceed with group discussions.
    22. 22. of Good bye Comandatuba…

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