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).
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 July 24, 2021.
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