Pathological evaluation of whole pancreas transplants

Abstract Pathological evaluation of whole pancreas transplants (WPnTx) is necessary for the accurate determination of the cause of graft dysfunction, graft failure, and graft insufficiency. In the early posttransplantation period, histological studies are essential to differentiate idiopathic graft thrombosis from thrombosis secondary to acute allograft rejection, most likely representing an aggressive form of antibody-mediated rejection (ABMR). Clinical manifestations of graft dysfunction have overall poor specificity. Histological studies are necessary to differentiate acute rejection from other causes of graft injury and are furthermore required to differentiate acute T-cell-mediated rejection (TCMR) from ABMR, which are treated differently. Equally important is the accurate identification of the various types of islet cell pathology, including calcineurin inhibitor toxicity and development of recurrent type 1 diabetes mellitus. Histological studies are also shedding light on the contribution of type 2 diabetes mellitus to graft dysfunction/insufficiency. This chapter includes a discussion of the Banff grading schema, as well as the various nonrejection-related pathological processes affecting WPnTx. In addition, the contribution of pathological evaluation in various other clinicopathological settings is presented.