There is little published data on the response of pancreas rejection to steroids alone. We reviewed 42 pancreas transplant recipients between 01/1997 and 12/2013 at our institution who had biopsy-proven first pancreas rejection and were treated with steroid pulse alone. Patients with borderline rejection on biopsy and those who received anti-thymocyte globulin (ATG) within four days of biopsy were excluded. Response to treatment was defined as normalization of lipase on day 14 which persisted at least 60 days. Patients not meeting this criterion or receiving ATG four or more days after biopsy were considered non-responders.

There were no significant differences in baseline characteristics between responders and non-responders (Table). 21 of 34 (62%) of patients with grade 1 rejection responded to treatment with steroids alone, while only 1 of 7 (14%) patients with grade 2 or 3 rejection responded. A trend toward more graft failure within one year from biopsy among non-responders was present, but did not reach statistical significance. One-year graft failure was 9% in patients with grade 1, 33.3% in grade 2 and 50% in grade 3 rejection (p-trend=0.01).

We conclude that many patients with grade 1 pancreas transplant rejection can be treated with steroids alone – most patients will respond with normalization of pancreas enzymes and graft failure is rare. In contrast, grade 2 and 3 rejection rarely responds to steroids alone and is associated with high graft failure rates. Higher grade rejection should probably be treated initially with ATG plus steroids, although further research is required to investigate outcomes with that approach.

CITATION INFORMATION: Salahuddin S, Astor B, Parajuli S, Djamali A, Odorico J, Mandelbrot D. Outcomes with Steroids Alone for Biopsy-Proven Pancreas Transplant Rejection. Am J Transplant. 2016;16 (suppl 3).

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