ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

How Should Pancreas Transplant Rejection Be Treated?

F. Aziz, S. Parajuli, S. Salahuddin, K. Harrold, A. Djamali, B. Astor, J. Odorico, D. Mandelbrot.

Department of Nephrology, University of Wisconsin, Madison.

Meeting: 2018 American Transplant Congress

Abstract number: A348

Keywords: Graft survival, Pancreas transplantation, Rejection

Session Information

Session Name: Poster Session A: Pancreas and Islet: All Topics

Session Type: Poster Session

Date: Saturday, June 2, 2018

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Hall 4EF

How Should Pancreas Transplant Rejection be Treated?

Background: There is limited information about how to approach the treatment of pancreas rejection, particularly regarding the use of steroids and anti-thymocyte globulin (ATG).

Methods: We reviewed the treatment and outcomes of 120 1st episode of biopsy-proven pancreas rejection. We compared response rates with steroids alone versus steroids plus ATG. A positive response to treatment was defined as sufficient improvement of pancreatic enzymes as assessed by clinic notes in the 90 days after treatment, and no further treatment provided within 90 days of the first rejection treatment.

Results: The mean age at the time of transplant was 40.7 years, 23% Pancreas only transplants, 58% simultaneous kidney-pancreas transplants and 19% pancreas after kidney transplants. The mean interval from transplant to biopsy was 16.1 ± 25.9 months. Out of 120 pancreas recipients, 53 (44%) had grade I rejection, 35 (29%) had grade II and 32 (27%) had grade III rejection. 56 patients were treated with steroids only (39 grade I, 12 grade II and 5 grade III). 79% of patients with grade I, 50% with grade II and 60% with grade III rejection responded to treatment with steroids alone. 64 patients were treated with ATG + steroids (14 grade I, 23 grade II and 27 grade III). The response rates were 57% in grade I, 78% in grade II and 70% in grade III.

Grade of Rejection Response with Steroids Alone Response with Steroids + ATG P-value
Grade I Rejection (n=53) 79% (31/39) 57% (8/14) 0.16
Grade II Rejection (n=35) 50% (6/12) 78% (18/23) 0.13
Grade III Rejection (n=32) 60% (3/5) 70% (19/27) 0.64

On univariate analysis, only grade of rejection predicted response to the treatment (HR: 0.74, 95%CI: 0.57 to 0.98, P = 0.03), and statistical significance was lost on multivariate analysis.

Conclusion: We do find that response rates to steroids plus ATG in patients with grade II or III rejection are quite good (>70%). However, we also find that patients with grade I rejection have a response rate of 79% to steroids alone. A substantial proportion of grade II or III rejections responded to steroids alone, but the sample size is quite small, and may not be representative. These findings suggest that initial treatment for grade 1 pancreas rejection should usually be with steroids alone, while initial treatment for grades II or III should usually be with steroids plus ATG.

CITATION INFORMATION: Aziz F., Parajuli S., Salahuddin S., Harrold K., Djamali A., Astor B., Odorico J., Mandelbrot D. How Should Pancreas Transplant Rejection Be Treated? Am J Transplant. 2017;17 (suppl 3).

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

To cite this abstract in AMA style:

Aziz F, Parajuli S, Salahuddin S, Harrold K, Djamali A, Astor B, Odorico J, Mandelbrot D. How Should Pancreas Transplant Rejection Be Treated? [abstract]. https://atcmeetingabstracts.com/abstract/how-should-pancreas-transplant-rejection-be-treated/. Accessed June 6, 2025.

« Back to 2018 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences