Although patients with advanced chronic rejection loose glycemic control, immunoperoxidase stains demonstrate a normal proportion of alpha and beta cells in the islets. Only a handful of cases have been reported of patients with recurrent Type 1 diabetes after pancreas transplantation. The lack of glycemic control in patients with severe chronic allograft rejection possibly related to similar mechanisms as the ones that lead to diabetes in patients with severe chronic pancreatitis. Arteries in grafts with chronic vascular rejection show intimal and medial fibrosis, subendothelial foam cells and occasionally hemosiderin deposition. Progressive occlusion of the arterial lumina ensues and in the most advanced stages the scarred vessel wall blends with the surrounding fibrous tissue and may be recognized only with elastic stains.
Clinical information is also necessary for an accurate diagnosis.
6th Congress of International Pancreas and Islet Transplant Association. Milan, September 24-27,1997. Histologic findings in islets of whole pancreas allografts. Lack of evidence for recurrent cell-mediated diabetes mellitus. Recurrent diabetes mellitus in the pancreas iso- and allograft.