Pancreas transplantation has become a standard therapy for type 1 diabetic patients. Although a short-term graft survival has been improved, a long-term graft survival is still far from ideal. Recently, a needle core biopsy of the pancreatic graft is safely indicated for the diagnosis of rejection by the patients who underwent pancreas transplantation.
Banff classification for the biopsy specimen of the kidney graft was applied for the pancreas since the 2007 Banff conference, and the Banff classification for rejection has been proposed in 2011. This classification includes acute cell-mediated rejection (Grades I-III), antibodv-mediated rejection (donor-specific antibody), morphological evidence of tissue injury, C4d positivity, chronic allograft arteriopathy., chronic allograft rejection/graft sclerosis (Stages l-lll), islet pathology, recurrence of autoimmune DM, and other histological diagnoses.
Recently, antibodv-mediated rejection (AMR), especially chronic AMR resulting in the pancreatic fibrosis, has been noticed and focused on at Banff conferences.