Refinement of diagnostic guidelines for TCMR, ABMR and islet processes, and differentiation from non-rejection pathologies. Duodenal cuff biopsies as surrogate for pancreas rejection and role of non-invasive diagnostic methods
Cinthia B. Drachenberg et al
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Abstract
The Banff pancreas working schema for diagnosis and grading of rejection is widely used for treatment guidance and risk stratification, in centers that utilize pancreas allograft biopsies. Since the last update, several studies provided additional insight regarding the application of the schema, and expanded the understanding of additional clinicopathological entities. Specifically, this update aims to clarify terminology and lesion description for T-cell mediated and antibody mediated allograft rejections, in both acute and chronic forms. Furthermore, morphological and immunohistochemistry tools are described, to distinguish rejection from non-rejection pathologies. For the first time, a comprehensive clinicopathological approach to islet processes in the early and late post-transplant periods is discussed. This update also includes a discussion on the potential utility of endoscopic duodenal cuff biopsies, as surrogates of pancreas biopsies in various clinical settings. Finally, the authors provide analysis and recommendations on the use of donor derived cell free DNA for monitoring pancreas graft recipients. A main goal of this multidisciplinary effort, is to offer an assessment of the current role of pancreas allograft biopsies, while at the same time providing practical guidelines that can be used by experiences as well as young pathologists, and be also meaningful to pancreas transplant practitioners in general.
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