Introduction.

Rejection or autoimmune recurrence is often difficult to diagnose in the field of pancreas transplantation. The place of pancreas graft biopsy in the management of pancreas transplant recipients is poorly defined. The aim of this study was to assess the contribution of pancreas graft biopsy in our cohort.

Methods.

All recipients of pancreas transplant, with or without simultaneous kidney transplant, who had a pancreas graft biopsy for cause since 2011 were included. Biopsies were performed under ultrasound or computer tomographic guidance. We analyzed indications, results, concordance with kidney graft biopsies, and complications.

Results.

Twenty-eight pancreas biopsies were performed in 24 patients. Six (21%) were non adequate. Twenty-one biopsies were performed for suspicion of rejection (increase in serum lipase n=17, de novo DSA n=2, kidney graft rejection n=2). Among them, 14 showed rejection (grade I cell-mediated rejection n=7, grade II cell-mediated rejection n=6, antibody-mediated rejection n=1) and only 3 were normal (4 non adequate). Evolution after treatment was favorable for all patients with grade I cell-mediated rejection. However, 5 out of 6 patients with grade II cell-mediated rejection lost their graft within 6 months. Concordance of pancreas biopsy with kidney biopsy in patients having a kidney graft from the same donor was poor (3 of 8). Four biopsies were performed for abnormal oral glucose tolerance test or appearance of autoantibodies. Islets were seen in 3 of these biopsies, without any abnormality. Biopsies for unexplained inflammatory syndrome were normal. There were no complications of biopsies.

Conclusion.

Pancreas graft biopsy is essential for the diagnosis and prognosis of pancreas rejection and must be performed in every case of increase in serum lipase or de novo DSA. Concordance with kidney biopsy is poor. The place of pancreas biopsy in autoimmune recurrence still has to be evaluated.

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