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In an analysis of 914 cadaver pancreas transplants performed at our center between 1999 and 2002, technical failure was found to be the most common cause of graft loss, accounting for 120 (13.1%) failed grafts. The second most common cause was chronic rejection, accounting for 80 (8.8%) of the failed grafts. The incidence of graft loss to chronic rejection was highest after isolated pancreas transplants (vs. simultaneous with a kidney). By multivariate analysis, the most significant risk factors for graft loss to chronic rejection were a previous episode of acute rejection (RR=13.75, p < 0.0001), an isolated (vs. simultaneous) transplant (RR=3.66, p=0.0004).

In summary, for the majority of transplant recipients, acute rejection and chronic rejection seem to be closely linked. Acute rejection episodes in these recipients represent the major risk factor for the eventual development of chronic rejection. As rates for acute rejection continue to decline, it will be interesting to see what impact this will have on the process of chronic rejection.

References

1. Matas AJ. Risk factors for chronic rejection—a clinical perspective. Transplant Immunol 1998; 6:1-11.

2. Humar A, Hassoun A, Kandaswamy R, et al. The questionable importance of nonimmunologic risk factors in long-term graft survival. JASN 1998; 9:7-8A.

3. Chavers BM, Mauer M, Gillingham KF, et al. Histology of acute rejection (AR) impacts renal allograft survival (GS) in patients (pts) with a single rejection episode (SRE). J Am Soc Nephrol 1995; 6:1076.

4. Drachenberg CB, Papadimitriou JC, Klassen DK, Weir MR, Cangro CB, Fink JC, Bartlett ST. Chronic pancreas allograft rejection: morphologic evidence of progression in needle biopsies and proposal of a grading scheme. Transplant Proc. 1999;31(1-2):614.

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