Accelerated pancreas allograft sclerosis due to allograft rejection

Evaluation of pancreas allograft biopsies is absolutely necessary to determine the cause of graft dysfunction in patients with solitary pancreas transplants. In the current era of solitary pancreas transplants with exocrine drainage to the native intestine, graft dysfunction is typically defined by increased levels of amylase and/or lipase in blood (signaling injury to the exocrine tissue) or by the development of hyperglycemia (endocrine dysfunction). Milder forms of rejection typically present with increase in pancreatic enzymes, whereas both endocrine and exocrine abnormalities are more commonly found in severe pancreatic rejection. Tissue evaluation in the patient presented here sequentially demonstrated T-cell-mediated rejection, mixed T-cell-mediated rejection/antibody-mediated rejection, and finally, advanced chronic rejection/graft sclerosis.