Pancreas Update(10 years since the 1st

pancreas session)

Cinthia Beskow Drachenberg, M.D.

Banff Pancreas Concurrent Session

I: Update on Pancreas Allograft Pathology Issues

-Discuss proposed revisions to the grading schema

II: Accurate Determination of the Cause of Graft Loss in Whole Pancreas Transplants

Utility of Duodenal Cuff Biopsies as a Surrogate for Diagnosis of Pancreas Rejection

Working group leader: Danni G. HolandaDepartment of Pathology, University of Iowa Carver College of Medicine Iowa City, IA

Utility of Duodenal Cuff Biopsies as a Surrogate for Diagnosis of Pancreas Rejection

-Few (increasing) number of centers areusing biopsies of the transplanted duodenalcuff for management of pancreas tx.

-Previous animal studies and early experiencewith cystoscopic biopsies in bladder drainagepancreas showed significant correlation for rejection between the duodenal cuff andthe pancreas.

Methods: Retrospective, multicenterevaluation of concurrently collected tissue samples from the duodenal cuff and pancreas allograft obtained intentionally or incidentally.

Samples and ResultsEvaluation of TCMR features in

duodenal intestinal mucosa and pancreas tissue

• 88 samples collected• 16 excluded

• 74 considered adequate for evaluation– 70% biopsies (remaining graft pancreatectomies)

A negative duodenal cuff biopsy 100% negative predictive value for pancreas rejection.Duodenal biopsy with features of rejection predicted rejection in 80% of pancreas biopsies.

CMV Infection of the Duodenal Cuff in Whole Pancreas Allografts

Erik Larsson Uppsala University Hospital, Sweden

Significant number of duodenal cuff biopsies demonstrated CMV infection.CMV infection correlated with increased risk for graft loss.

Pale Acinar NodulesMegan Troxell

Oregon Health & Science University.

Clusters of acinarcells with different tinctorial appearance.Can be seen in nativepancreas.Can be confused with islets but are not neuroen-docrine in nature. No correlationwith medications or demographics.Several session participantsfavored Ischemic injury as a potential cause.

Clinical Impact of Performing Concurrent Pancreas-Kidney Allograft Biopsies

María Fernanda TonioloNephrology Institute, Buenos Aires , Argentina

SPK transplants

Complete work-up of 44 simultaneous P and K biopsies including concurrent DSA, C4d and BK studies. - 4 cases of AMR: concordant in both organs- Significant discrepancy between K and P for ACMR.

Consensus Discussion for revision o the Pancreas Banff Schema

Working group leaders: • Hanneke de Kort and Candice Roufosse

- Grading of ABMR severity incorporated to the main schema

- Correction of terminology to facilitate understanding, and for consistency

- Improved definitions for chronic TCMR and chronic ABMR

- Inclusion of Beta cell islet toxicity in the category of islet pathology

Banff Pancreas Concurrent Session

I: Update on Pancreas Allograft Pathology Issues

-Discuss proposed revisions to the grading schema

II: Accurate Determination of the Cause of Graft Loss in Whole Pancreas Transplants

Morphological Spectrum of Lesionsassociated with graft failure

John Papadimitriou

Pancreas graft failure = Islet failureThree morphological settings• Pancreas tissue necrosis, destruction of islets

• Pancreas tissue fibrosis, disappearance of islets

• Primary islet dysfunction, islets present but not working well

“Technical failure”Acute antibody mediated rejection

Chronic T-cell mediated rejectionChrnoic Antibody mediated rejection

Recurrence of Type 1 DMDevelopment off Type 2 DMBeta cell islet toxicity (CNI)

Insulin Glucagon

II: Accurate Determination of the Cause of Graft Loss in Whole Pancreas Transplants

Jon Odorico: Moderator

Clinicopathological Algorithm for the Accurate Etiological Diagnosis of Graft Failure in Pancreas Transplants

Functional studies: glucose tolerancec-peptide, etc

Pathology

Serological studies: DSA, anti-islet antibodies

Proposal by Dr. S. Paraskevas

• Working groups for Banff 2017

- Vascular lesions: significance for ABMR and graft prognosis: Hanneke de Kort – Candice Roufosse

- Development of scoring guidelines for specific lesions and working group for reproducibility: Brad Farris – Lois Arend.

- Molecular studies: Candice Roufosse.