It is commonly assumed that in simultaneous kidney and pancreas (SPK) recipients the rejection of the two organs will be concordant. As a result, simultaneous biopsies of both organs are relatively rarely performed, so there exists limited histological data on how often rejection is in fact discordant. We reviewed all SPK recipients transplanted between 01/1/02 to 06/30/14 that underwent biopsy of both organs. We included all patients whose biopsies were within 30 days. If patients were treated for rejection between biopsies, they were excluded if the biopsies were more than 4 days apart. Biopsies of explanted organs and post-reperfusion biopsies were also excluded. 72 simultaneous biopsies were performed within 30 days and 31 met our inclusion criteria. 18 (58%) patients had concordance of biopsy findings; 10 had rejection of both organs and 8 had no rejection of either organ. The other 13 (42%) were discordant for rejection, with 10 having pancreas-only rejection and 3 kidney-only rejection. It was striking to find that only 7 of 10 patients with concordance for rejection had the same type (AMR, ACR or mixed) of rejection i.e. there was a 30% discordance rate in rejection type.

This large series of simultaneous kidney and pancreas biopsies demonstrates the continued utility of performing biopsies of both organs – 40% of these are discordant for the presence or absence of rejection and of those found to have rejection in both organs, 30% were discordant for the type of rejection.

CITATION INFORMATION: Parajuli S, Astor B, Djamali A, Redfield R, Arpali E, Kaufman D, Odorico J, Mandelbrot D. Lessons Learned from Simultaneous Biopsies of Both Kidney and Pancreas Grafts in Recipients of Simultaneous Kidney-Pancreas Transplants. Am J Transplant. 2017;17 (suppl 3).

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