Impact of Pancreatic Autoantibodies in Pancreas Graft Survival After Pancreas-Kidney Transplantation

• Published in: Transplantation proceedings 2020-06, Vol.52 (5), p.1370-1375
• Main Authors: Pestana, Nicole, Malheiro, Jorge, Silva, Filipa, Silva, Andreia, Ribeiro, Catarina, Pedroso, Sofia, Almeida, Manuela, Dias, Leonídio, Henriques, António Castro, Martins, La Salete
• Format: Article
• Language: English
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2020.02.035

In simultaneous pancreas-kidney transplantation (SPKT), persistence or recurrence of pancreatic autoantibodies (PAs) has been associated with pancreas graft (PG) autoimmune-driven injury. Our aim was to analyze the impact of PAs on PG survival. Between January 1, 2000, and December 31, 2017, we studied 139 patients with post-SPKT anti–glutamic acid decarboxylase (GAD) autoantibody. Alloimmune (ALI) events were defined as PG rejection and/or de novo donor-specific antibodies (DSA). Hence, 3 groups were defined: patients without ALI events or anti-GAD (n = 42), those with ALI events (n = 14), or those only with autoimmune events (positive for anti-GAD and no ALI events; n = 83). Male sex was predominant (n = 72, 52%). Median age was 35 years (interquartile range: 31-39) and median follow-up was 6-7 years (interquartile range: 4.1-9.2). Regarding anti-GAD positivity post-SPKT (n = 90, 65%), no differences were observed concerning age, sex, anti-HLA antibodies, HLA mismatch number and de novo DSA. ALI events were present in 10% (n = 14). PG survival 15 years post-SPKT was better in patients without immune events (96%) followed by those with ALI (69%) and autoimmune events (63%) (P = .025). Anti-GAD was associated to higher annualized mean Hb1AC (P = .006) and lower mean C-peptide (P = .013). According to pre- and post-SPKT anti-GAD status, conversion from negative to positive was associated to worse (63%) 10-year PG survival (P = .044), compared to persistence of negative (100%) or positive anti-GAD (88%). Anti-islet cell and anti-insulin autoantibodies had no impact. Anti-GAD presence post-SPKT was associated to higher pancreas disfunction and lower PG survival. De novo anti-GAD seems to offer a particular risk of PG failure. •Autoimmune and alloimmune events have a negative impact on pancreas graft survival.•Autoantibody conversion is associated with a high risk of developing insulin-dependent diabetes mellitus after simultaneous pancreas-kidney transplantation.•Worse function of the pancreas graft and lower survival in SPKT are strongly associated to emergence of anti–glutamic acid decarboxylase (GAD).