Korean J Transplant.  2023 Nov;37(Suppl 1):S105. 10.4285/ATW2023.F-6878.

A case report of antibody-mediated rejection after re-pancreas transplant alone

• Sho J
• Ko Y
• Min T
• Choi B

• KMID: 2551725
• DOI: http://doi.org/10.4285/ATW2023.F-6878

Abstract

In insulin-dependent diabetic patients without renal dysfunction, pancreas transplantation alone (PTA) is one of the treatment options. However, antibody-mediated rejection (AMR) after organ transplant is the one of the primary obstacles to expanding the PTA criteria. Here, we report graft failure in a re-pancreas transplant recipient due to AMR. A 42-year-old male with type 1 diabetes and frequent hypoglycemia received a transplant of the pancreas alone. The operation itself was successful, and the recipient was discharged from the hospital in a normoglycemic state without any exogenous insulin treatment. However, serum levels of amylase and lipase were elevated 4 months after transplantation. A biopsy guided by ultrasound was performed, and the pathology report revealed indeterminate acute cellular rejection. After steroid pulse therapy, the enzyme level was normalized, but the function of the graft was impaired. A second pancreas transplant was conducted 2 years after the initial transplant. The anti-DQ8 antibody at the retransplant was donor-specific antibody (MFI 1717). The recipient was discharged with a functioning pancreas transplant. One month after retransplantation, serum amylase and lipase were elevated. Again, a biopsy was performed; the C4d stain was positive, and the result was consistent with pancreas graft AMR. The total of seven times of plasmapheresis and thymoglobulin treatment was done as an antirejection treatment; however, the graft function decreased, and finally, reuse of insulin was needed. The risk of transplantation is nearly eliminated completely, but rejection, especially AMR, remains a complex issue in pancreas transplantation. Retransplantation of the pancreas should be performed with caution, and it is preferable to avoid donors with the same human leukocyte antigen against the recipient's antibody.