Pancreas summary from the 2015 Vancouver Banff Transplant Pathology Meeting presented by Dr. Cynthia Drachenberg October 9, 2015.

1. Pancreas Update
(10 years since the 1st
pancreas session)
Cinthia Beskow Drachenberg, M.D.

2. Banff Pancreas Concurrent Session
I: Update on Pancreas Allograft Pathology
Issues
-Discuss proposed revisions to the grading
schema
II: Accurate Determination of the Cause of Graft
Loss in Whole Pancreas Transplants

3. Utility of Duodenal Cuff Biopsies as a Surrogate
for Diagnosis of Pancreas Rejection
Working group leader: Danni G. Holanda
Department of Pathology, University of Iowa Carver College of
Medicine Iowa City, IA

4. Utility of Duodenal Cuff Biopsies as a Surrogate
for Diagnosis of Pancreas Rejection
-Few (increasing) number of centers are
using biopsies of the transplanted duodenal
cuff for management of pancreas tx.
-Previous animal studies and early experience
with cystoscopic biopsies in bladder drainage
pancreas showed significant correlation
for rejection between the duodenal cuff and
the pancreas.
Methods: Retrospective, multicenter
evaluation of concurrently collected
tissue samples from the duodenal cuff
and pancreas allograft obtained
intentionally or incidentally.

5. Samples and Results
Evaluation of TCMR features in
duodenal intestinal mucosa and pancreas tissue
• 88 samples collected
• 16 excluded
• 74 considered adequate for evaluation
– 70% biopsies (remaining graft pancreatectomies)
A negative duodenal cuff biopsy 100% negative
predictive value for pancreas rejection.
Duodenal biopsy with features of rejection predicted
rejection in 80% of pancreas biopsies.

6. CMV Infection of the Duodenal Cuff in
Whole Pancreas Allografts
Erik Larsson
Uppsala University Hospital, Sweden
Significant number of duodenal cuff biopsies demonstrated
CMV infection.
CMV infection correlated with increased risk for graft loss.

7. Pale Acinar Nodules
Megan Troxell
Oregon Health & Science University.
Clusters of acinar
cells with different
tinctorial appearance.
Can be seen in native
pancreas.
Can be confused with
islets but are not neuroen-
docrine in nature.
No correlation
with medications or demo
graphics.
Several session participants
favored Ischemic injury as a potential cause.

8. Clinical Impact of Performing Concurrent
Pancreas-Kidney Allograft Biopsies
María Fernanda Toniolo
Nephrology Institute, Buenos Aires , Argentina
SPK transplants
Complete work-up of 44 simultaneous P and K biopsies including
concurrent DSA, C4d and BK studies.
- 4 cases of AMR: concordant in both organs
- Significant discrepancy between K and P for ACMR.

9. Consensus Discussion for revision o
the Pancreas Banff Schema
Working group leaders:
• Hanneke de Kort and Candice Roufosse
- Grading of ABMR severity incorporated to the
main schema
- Correction of terminology to facilitate
understanding, and for consistency
- Improved definitions for chronic TCMR and
chronic ABMR
- Inclusion of Beta cell islet toxicity in the category
of islet pathology

10. Banff Pancreas Concurrent Session
I: Update on Pancreas Allograft Pathology
Issues
-Discuss proposed revisions to the grading
schema
II: Accurate Determination of the Cause of Graft
Loss in Whole Pancreas Transplants

11. Morphological Spectrum of Lesions
associated with graft failure
John Papadimitriou

12. Pancreas graft failure = Islet failure
Three morphological settings
• Pancreas tissue necrosis, destruction of islets
• Pancreas tissue fibrosis, disappearance of
islets
• Primary islet dysfunction, islets present but
not working well
“Technical failure”
Acute antibody mediated rejection
Chronic T-cell mediated rejection
Chrnoic Antibody mediated rejection
Recurrence of Type 1 DM
Development off Type 2 DM
Beta cell islet toxicity (CNI)

13. Insulin Glucagon

14. II: Accurate Determination of the Cause of Graft
Loss in Whole Pancreas Transplants
Jon Odorico: Moderator

15. Clinicopathological Algorithm for the Accurate Etiological
Diagnosis of Graft Failure in Pancreas Transplants
Functional
studies:
glucose
tolerance
c-peptide, etc
Pathology
Serological
studies:
DSA, anti-islet
antibodies
Proposal by Dr. S. Paraskevas

16. • Working groups for Banff 2017
- Vascular lesions: significance for ABMR and
graft prognosis: Hanneke de Kort – Candice
Roufosse
- Development of scoring guidelines for specific
lesions and working group for reproducibility:
Brad Farris – Lois Arend.
- Molecular studies: Candice Roufosse.