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Pancreas summary banff 2015

Pancreas summary from the 2015 Vancouver Banff Transplant Pathology Meeting presented by Dr. Cynthia Drachenberg October 9, 2015.

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Pancreas summary banff 2015

  1. 1. Pancreas Update (10 years since the 1st pancreas session) Cinthia Beskow Drachenberg, M.D.
  2. 2. Banff Pancreas Concurrent Session I: Update on Pancreas Allograft Pathology Issues -Discuss proposed revisions to the grading schema II: Accurate Determination of the Cause of Graft Loss in Whole Pancreas Transplants
  3. 3. Utility of Duodenal Cuff Biopsies as a Surrogate for Diagnosis of Pancreas Rejection Working group leader: Danni G. Holanda Department of Pathology, University of Iowa Carver College of Medicine Iowa City, IA
  4. 4. Utility of Duodenal Cuff Biopsies as a Surrogate for Diagnosis of Pancreas Rejection -Few (increasing) number of centers are using biopsies of the transplanted duodenal cuff for management of pancreas tx. -Previous animal studies and early experience with cystoscopic biopsies in bladder drainage pancreas showed significant correlation for rejection between the duodenal cuff and the pancreas. Methods: Retrospective, multicenter evaluation of concurrently collected tissue samples from the duodenal cuff and pancreas allograft obtained intentionally or incidentally.
  5. 5. Samples and Results Evaluation of TCMR features in duodenal intestinal mucosa and pancreas tissue • 88 samples collected • 16 excluded • 74 considered adequate for evaluation – 70% biopsies (remaining graft pancreatectomies) A negative duodenal cuff biopsy 100% negative predictive value for pancreas rejection. Duodenal biopsy with features of rejection predicted rejection in 80% of pancreas biopsies.
  6. 6. CMV Infection of the Duodenal Cuff in Whole Pancreas Allografts Erik Larsson Uppsala University Hospital, Sweden Significant number of duodenal cuff biopsies demonstrated CMV infection. CMV infection correlated with increased risk for graft loss.
  7. 7. Pale Acinar Nodules Megan Troxell Oregon Health & Science University. Clusters of acinar cells with different tinctorial appearance. Can be seen in native pancreas. Can be confused with islets but are not neuroen- docrine in nature. No correlation with medications or demo graphics. Several session participants favored Ischemic injury as a potential cause.
  8. 8. Clinical Impact of Performing Concurrent Pancreas-Kidney Allograft Biopsies María Fernanda Toniolo Nephrology Institute, Buenos Aires , Argentina SPK transplants Complete work-up of 44 simultaneous P and K biopsies including concurrent DSA, C4d and BK studies. - 4 cases of AMR: concordant in both organs - Significant discrepancy between K and P for ACMR.
  9. 9. Consensus Discussion for revision o the Pancreas Banff Schema Working group leaders: • Hanneke de Kort and Candice Roufosse - Grading of ABMR severity incorporated to the main schema - Correction of terminology to facilitate understanding, and for consistency - Improved definitions for chronic TCMR and chronic ABMR - Inclusion of Beta cell islet toxicity in the category of islet pathology
  10. 10. Banff Pancreas Concurrent Session I: Update on Pancreas Allograft Pathology Issues -Discuss proposed revisions to the grading schema II: Accurate Determination of the Cause of Graft Loss in Whole Pancreas Transplants
  11. 11. Morphological Spectrum of Lesions associated with graft failure John Papadimitriou
  12. 12. Pancreas graft failure = Islet failure Three morphological settings • Pancreas tissue necrosis, destruction of islets • Pancreas tissue fibrosis, disappearance of islets • Primary islet dysfunction, islets present but not working well “Technical failure” Acute antibody mediated rejection Chronic T-cell mediated rejection Chrnoic Antibody mediated rejection Recurrence of Type 1 DM Development off Type 2 DM Beta cell islet toxicity (CNI)
  13. 13. Insulin Glucagon
  14. 14. II: Accurate Determination of the Cause of Graft Loss in Whole Pancreas Transplants Jon Odorico: Moderator
  15. 15. Clinicopathological Algorithm for the Accurate Etiological Diagnosis of Graft Failure in Pancreas Transplants Functional studies: glucose tolerance c-peptide, etc Pathology Serological studies: DSA, anti-islet antibodies Proposal by Dr. S. Paraskevas
  16. 16. • Working groups for Banff 2017 - Vascular lesions: significance for ABMR and graft prognosis: Hanneke de Kort – Candice Roufosse - Development of scoring guidelines for specific lesions and working group for reproducibility: Brad Farris – Lois Arend. - Molecular studies: Candice Roufosse.

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