Antibody-mediated rejection (AMR) after pancreas and pancreas–kidney transplantation


Érika B. Rangel MD, PhD, Avenida Albert Einstein, 627/701, Morumbi 05651-901, São Paulo, SP, Brazil. Tel.: +55 11 37473090; fax: +55 11 37473090; e-mail:


Antibody-mediated rejection (AMR) requires specific diagnostic tools and treatment and is associated with lower graft survival. We prospectively screened C4d in pancreas (= 35, in 27 patients) and kidney (= 33, in 21 patients) for cause biopsies. Serum amylase and lipase, amylasuria, fasting blood glucose (FBG) and 2-h capillary glucose (CG) were also analysed. We found that 27.3% of kidney biopsies and 43% of pancreatic biopsies showed C4d staining (66.7% and 53.3% diffuse in peritubular and interacinar capillaries respectively). Isolated exocrine dysfunction was the main indication for pancreas biopsy (54.3%) and was followed by both exocrine and endocrine dysfunctions (37.1%) and isolated endocrine dysfunction (8.6%). Laboratorial parameters were comparable between T-cell mediated rejection and AMR: amylase 151.5 vs. 149 U/l (= 0.075), lipase 1120 vs. 1288.5 U/l (= 0.83), amylasuria variation 46.5 vs. 61% (= 0.97), FBG 69 vs. 97 mg/dl (= 0.20) and 2-h CG maximum 149.5 vs. 197.5 mg/dl (= 0.49) respectively. Amylasuria values after treatment correlated with pancreas allograft loss (= 0.015). These data suggest that C4d staining should be routinely investigated when pancreas allograft dysfunction is present because of its high detection rate in cases of rejection.