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Pathology of Pancreas Transplant

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Contemporary Pancreas Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Accurate determination of the cause of pancreas allograft dysfunction requires histological evaluation of the transplanted organ. Guidelines are available for systematic morphological evaluation and optimal clinicopathological integrations. Furthermore, morphological characterization of the main histopathological types of acute rejection, T-cell-mediated rejection (TCMR) and antibody mediated allograft rejection (AMR), has allowed for a better differentiation from each other and from other non-rejection-related pathological processes.

Acute TCMR is characterized by active parenchymal cellular infiltrates composed predominantly of T cells and typically involving veins, ducts, acini, and occasionally arterial branches. The main differential diagnosis of TCMR includes infectious processes such as cytomegalovirus infection and EBV-related posttransplant lymphoproliferative disorder, both of which also present with inflammatory cellular infiltrates.

Significant parenchymal involvement in acute AMR, on the other hand, is characterized by predominantly macrophagic (± neutrophilic) inflammation and typically C4d-positive microvasculature injury. Patchy or diffuse hemorrhagic necrosis in AMR requires consideration of a different set of differential diagnoses, mainly including ischemic pancreatitis and vascular graft thrombosis due to technical issues.

Accurate diagnosis of TCMR and AMR, as well as mixed forms of rejection, requires (1) systematic analysis of the histological features, (2) evaluation of C4d staining, and (3) determination of the DSA status.

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Authors and Affiliations

  1. University of Maryland School of Medicine, University of Maryland Hospital, 22 South Greene St, Baltimore, MD, 21201, USA

    Cinthia B. Drachenberg & John C. Papadimitriou

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  1. Cinthia B. Drachenberg
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  2. John C. Papadimitriou
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Correspondence to Cinthia B. Drachenberg .

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  1. Organ Transplantation, Hackensack University Medical Center Transplant Surgery and, Hackensack, New Jersey, USA

    James W. Lim

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Drachenberg, C.B., Papadimitriou, J.C. (2016). Pathology of Pancreas Transplant. In: Lim, J. (eds) Contemporary Pancreas Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-20789-6_10-2

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  • DOI: https://doi.org/10.1007/978-3-319-20789-6_10-2

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  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-20789-6

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  1. Latest

    Pathology of Pancreas Transplant
    Published:
    28 September 2016

    DOI: https://doi.org/10.1007/978-3-319-20789-6_10-2

  2. Original

    Pathology of Pancreas Transplant
    Published:
    16 March 2016

    DOI: https://doi.org/10.1007/978-3-319-20789-6_10-1

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