Duodenal and Pancreatic Graft Biopsies as Immunological Monitoring After Portal-Duodenal Drained Pancreas Transplants

Portal-duodenal drainage(PDD) in pancreas transplantation(PT) is a new surgical alternative and opens a wide possibility of monitoring and intervention of the graft. We have performed protocol endoscopic graft duodenum biopsies(EGDB) and pancreatic biopsies(PB) percutaneously or by echoendoscopy combined to EGDB in cases of graft dysfunction. From February/2010 to April/2013 we analyzed 55 graft biopsies in 30 patients, being 24 PAK, 5 PTA and 1 simultaneous pancreas and living-donor kidney (SPLK) transplant. EGDB showed a good correlation(78%) with PB and was able to detect silent rejection in almost 6% of protocol biopsies. The low incidence of immunological loss in this series of solitary PT and SPLK, which are categories of PT admittedly more immunogenic, suggests that protocol EGDB combined (or not) to PB in cases of dysfunction may become a helpful monitoring tool in a new scenario of PT with PDD technique.