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Chronic Pancreas Graft Rejection — ESENeph MCQ

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HardTransplantationChronic Pancreas Graft RejectionESENeph

A 35-year-old man with type 1 diabetes and a functioning SPK transplant 3 years ago develops polyuria and rising blood glucose. His pancreas graft has been functioning well with insulin independence. Lipase is normal. C-peptide is falling. What should be investigated?

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Correct answer: D — Chronic pancreas graft rejection – declining C-peptide with rising glucose indicates graft dysfunction

Falling C-peptide (indicating declining insulin production) with rising blood glucose in an SPK recipient suggests chronic pancreas graft dysfunction, most commonly from chronic rejection. Monitoring includes regular C-peptide, HbA1c, and fasting glucose. A pancreas graft biopsy (often CT-guided) may be needed but is technically challenging. Donor-specific antibodies should be checked. Treatment involves optimising immunosuppression. Pancreas graft loss eventually requires return to insulin therapy.

Reference: KDIGO 2009 – Transplant; Gruessner et al 2016 – Pancreas Transplant Outcomes