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Correspondence to Author: Lucas M. Garcias ¹ , Santiago Reimondez ¹ , Enzo Giordano ¹ , Álvaro Alcaraz ¹ , Marcos Marani ¹ , Gustavo Muiño ² , Martín Maraschio¹. 

1. Hepatobiliopancreatic Surgery and Transplant Unit, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
2. Radiology Service, Hospital Privado Universitario de Córdoba, Córdoba, Argentina

DOI: 10.52338/joct.2026.5595

Abstract:

SPK is currently the optimal therapeutic approach to enhance both quality of life and overall survival in highly selected patients with type 1 or type 2 diabetes and end-stage renal disease1-3. The first successful pancreas transplantation was performed in 19664,5. By 2014, over 48,000 pancreas transplants had been performed worldwide, with numbers continuing to rise5,6. During the post-transplant follow-up of SPK, close monitoring is essential, encompassing clinical evaluation, laboratory parameters and imaging studies. Although multiple biological biomarkers are useful in detecting acute rejection, amylase and lipase levels remain the parameters across centers due to their sensitivity exceeding 70%. In fact, Serum amylase and lipase levels are routinely monitored postoperatively and should remain within normal ranges. However, elevations in these enzyme levels, although very useful, are relatively common, often complicating the differential diagnosis. In such cases, pancreatic biopsy is frequently required to confirm the diagnosis4. Pancreas transplant (PT) biopsy is a well-established procedure and remains the gold standard for differentiating causes of transplant failure, such as rejection, inflammation, or medication-associated toxicity4,7. Among these, rejection stands out as the most common cause of pancreatic graft loss6. The role of rejection and chronic injury in pancreas graft loss is still not well understood, largely because rejection rates tend to be underreported. This happens because many centers are cautious about performing pancreas biopsies, either due to the risk of complications or because of limited resources8. Rejection rates can vary depending on the immunosuppression protocols employed by each transplant center4,9. Notably, in simultaneous pancreas-kidney transplantation (SPK), diagnosing pancreatic rejection should not be based on kidney biopsy findings due to the low concordance between the two grafts. Recent studies have demonstrated this discrepancy, highlighting the necessity of pancreatic biopsy for accurate diagnosis8. According to the Scientific Registry of Transplant Recipients (SRTR) report for 2016–2017, the incidence of acute pancreatic rejection within the first year was 11.7% for pancreas after kidney (PAK), 19.2% for pancreas transplant alone (PTA), and 12.4% for SPK8 figures that are far from negligible, further emphasizing the critical need for pancreatic biopsy. In this study, we report a case series of pancreatic graft biopsies performed as part of the follow-up of patients undergoing SPK and PTA at a high-volume transplant center in Latin America. The primary objective is to evaluate the efficacy of biopsies as a diagnostic tool for detecting rejection and to analyze the potential complications associated with this procedure.

Citation:

Dr. Lucas M. Garcias, Outcomes Of Pancreatic Biopsies In Simultaneous Pancreas And Kidney (Spk) Transplantation For Suspected Acute Rejection. Journal of Clinical Transplantation 2026.