A different technique for the diagnosis of pancreas allograft rejection after bladder drained simultaneous kidney pancreas transplantation (SKPtx)

Eş zamanlı böbrek ve pankreas transplantasyonu sonrası izole pankreas rejeksiyönünün anlaşılması güçleşmektedir. İdrar amilazında azalma, serum anodal tripsinojen düzeyinde artma gibi belirleyici faktörler olmasına karşın rejeksiyon için en iyi teşhis metodu pankreasın iğne biopsisidir. Bu yönteminde fıstül gelişimi,psödokist oluşumu,kanama gibi korkutucu sonuçları bulunmaktadır. Pankreas greftinin implantasyonunda ekzokrin salgının drene edilme yöntemi tartışmalıdır. Son yıllarda pankreasın aynı kadavradan alınan duodenal allograft vasıtasıyla mesaneye drenaj yöntemi daha çok kullanılmaktadır. Pankreas ve duodenal allograft birlikte rejeksiyona uğramakta bu esnada da benzer histolojik bulgular gelişmektedir. Pankreas iğne biopsisinin korkulan sonuçlarından dolayı rejeksiyonun anlaşılması için duodenal allograft biopsi alınacak organ olarak kullanılabilir. Makalede bu konudaki deneyimimiz, teknik donanım ve sonuçlar anlatılmaktadır.

Mesane drenajlı eş zamanlı böbrek ve pankreas transplantasyonları sonrası izole pankreas rejeksiyonunun anlaşılmasında kullanılan farklı bir teknik

Present methods of monitoring pancreas allograft dysfunction in bladder drained simultaneous kidney pancreas transplants (SKPtx) give indirect evidence and do not consistently allow recognition of potentially reversible refection from other causes of allograft dysfunction. For better diagnosis of pancreas dysfunction, adequate tissue specimens must be obtained without trauma to the allograft.. Needle biopsy of the pancreas has had a reputation as a dangerous procedure in general pancreatic surgery because fatal complications-hemorrhage, pancreatitis, fistulas, pseudocysts, and abscesses-are reported. Previous histologie studies have revealed a correlation between duodenal allograft and pancreatic aciner findings during the rejection process. The duodenal allograft can easily be visualized cystoscopically and is readily accessible to biopsy. We described a cystoscopically directed needle biopsy technique to obtain tissue from the duodenal allograft as a marker of refection after SKPtx.

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1. Boonstra JG, Bruijn JA, Hermans J. The incidence of interstitial and vascular kidney rejection after pancreas-kidney transplantation. J Am Soc Nephrol 1995; 5: 1918-1925. 2. Raymond J, Mitchell L, Elmahdi A. The frequency of rejection episodes after combined kidney-pancreas transplant-the impact on graft survival. Transplantation 1994; 58: 424-430. 3. David K, Edward W, Matthew R. Isolated pancreas rejection in combined kidney pancreas transplantation.Transplantation 1996; 61: 974-977. 4. Sutherland DER, Gruessner RWG, Gores PF. Pancreas and islet cell transplantation: an update. Trans Rev 1994;8: 185. 5. Moukarzel M, Benoit G, Charpentier B. Is urinary amylase a reliable index for monitoring whole pancreas endocrine graft function? Transplant proc 1992; 24: 925. 6. Cinthia B, John C, David K, Lorraine C. Evaluation of pancreas transplant needle biopsy. Transplantation 1997;63: 1579-1586. 7. Allen RDM, Wilson TG, Grierson JM. Percutaneous biopsy of bladder-drained pancreas transplants.Transplantation 1991; 51: 1213. 8. D'Allesandron AM, Sollinger HW, Strata RJ, Kalayoğlu M. Comparison between duodenal button and duodenal segment in pancreas transplantation. Transplantation 1989; 47: 120-122. 9. Carpenter HA, Barr D, Marsh CL, Miller AR. Sequential histopathologic changes in pancreaticoduodenal allograft rejection in dogs. Transplantation 1989; 48: 764-768. 10. Carpenter HA, Engen DE, Munn SR. Histologic diagnosis of rejection by using cystoscopically directed needle biopsy specimens from dysfunctional pancreatoduodenal allografts with exocrine drainage into the bladder. Am J SurgPathol 1990;14: 837-846. 11. Nakhleh RE, Benedetti E, Gruessner A. Cystoscopic biopsies in pancreaticoduodenal transplantation:are duodenal biopsies indicative of pancreas dysfunction? Transplantation 1995; 60: 541.
12. Nakhleh RE, Sutherland DE, Tzardis P, Schechner R.Correlation of rejection of the duodenum with rejection of the pancreas in a pig model of pancreaticoduodenal transplantation. Transplantation 1993; 56: 1353. 13. Laftavi MR, Gruessner AC, Bland BJ. Diagnosis of pancreas rejection:cystoscopic transduodenal versus percutaneous computed tomography scan-guided biopsy.Transplantation 1998; 65: 528. 14. Nghiem DD. Role of duodenal biopsy in bladder-drained pancreas transplants. Transplant Proc 1992; 24: 1247. 15. Reggiani P, Gatti S, Colledan M. Duodenal gross and microscopic findings after spleno-duodeno-pancreatic allotransplantation in the pig. Transplant Proc 1992; 24:1077.