05-5: SIX YEARS EVALUATION OF PERCUTANEOUS PANCREAS GRAFT BIOPSIES, REJECTION FACTORS AND ALLOGRAFT SURVIVAL.

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Introduction: This study aims to retrospectively assess the chosen demographic data feasibly contributing to the pancreas grafts rejection, the safety of percutaneous biopsies and finally the impact of diverse types of rejection on pancreas graft survival. Methods: Univariate and multivariate analysis were performed to identify the risk factors for pancreas graft rejection. Then Logrank test was used to assess the graft survival in all types of ACR (acute cellular rejection), ABMR (antibody-mediated rejection) together with chronic rejection and borderline histopathology findings. Moreover, the study examines the safety of performed biopsies and calculating the treatment’s effect on indeterminate biopsies outcomes, by using a chi square test. Results: From 2018 to early 2024, a total of 194 pancreatic biopsies were indicated in 152 transplanted patients. Multivariate Cox regression revealed that DSA (donor specific antibodies) level is a significant factor contributing to rejection occurrence (p = 0.048). Furthermore, Univariate Cox regression analysis identified that variability in trough blood levels of immunosuppressive drugs is also a significant factor associated with pancreas rejection (p < 0.0001). Diagnostic examination confirmed ongoing rejections in 120 biopsies, including indeterminate and chronic rejection signs. The five-year graft survival in the subgroups of indeterminate, ACR grade I, II, III and ABMR together with chronic rejection was 73%, 65%, 50%, 46% and 50% respectively (p = 0.0027). To evaluate the safety of pancreas graft biopsies, we detected a number of 20 post-biopsy complications out of 194 performed ones, where only 2% of patients needed to undergo a surgical intervention. Conclusions: Pancreas graft rejection is a complex process, where a comprehensive approach of diagnostics and treatment evaluation should be carefully appraised. Our analysis conceivably identified two factors that contributed to the increased rate of rejection. Furthermore, percutaneous graft biopsy remains a secure procedure to support clinical decision-making and helps to estimate pancreas graft survival.

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