Acute Rejection, Pancreas

Acute Rejection, Pancreas is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • The majority of rejection episodes occur within the first 6 months after transplant. Unlike other organs, clinical findings and biochemical markers correlate poorly with rejection; in particular, if hyperglycemia occurs because of rejection, it is often late, severe, and irreversible. Because 80% of pancreas transplants are performed with a simultaneous kidney transplant with the same immunologic status, renal allograft function and histopathology can be a valuable surrogate for diagnosis of pancreas allograft rejection.
  • Most pancreas transplants are done with quadruple immunosuppression, consisting of an induction agent and triple maintenance immunosuppression, including corticosteroids. One-year posttransplant acute rejection rates range between 20% and 30%; this contributes significantly to early and late graft loss.

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General Principles

  • The majority of rejection episodes occur within the first 6 months after transplant. Unlike other organs, clinical findings and biochemical markers correlate poorly with rejection; in particular, if hyperglycemia occurs because of rejection, it is often late, severe, and irreversible. Because 80% of pancreas transplants are performed with a simultaneous kidney transplant with the same immunologic status, renal allograft function and histopathology can be a valuable surrogate for diagnosis of pancreas allograft rejection.
  • Most pancreas transplants are done with quadruple immunosuppression, consisting of an induction agent and triple maintenance immunosuppression, including corticosteroids. One-year posttransplant acute rejection rates range between 20% and 30%; this contributes significantly to early and late graft loss.

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