Chronic Pancreas Allograft Failure

Apancreas transplant is the only treatment ofdiabetes mellitus that establishes long-term insulin independence. As of December 31, 2006, about20, 000pancreas transplants had been performed in the United States, with 1-year graft survival rates of >80% and patient survival rates of >95%. Results have significandy improved over the last decade, primarily thanks to a marked reduction in technical and immunologic failure. The goal of a pancreas transplant is not only to normalize the recipients glucose metabolism but also to halt or reverse the progression of secondary diabetic complications (e.g., nephropathy, neuropathy, retinopathy) and to improve quality of life. Almost 47% of all pancreas allografts are now functioning at 10 years posttransplant; chronic rejection remains the main cause of late pancreas allograft failure. Herein, we discuss the diagnosis and histopathologic findings of, as well as risk factors for, chronic rejection, including options to decrease its incidence.