Demetris A J, Ruppert K, Dvorchik I, Jain A, Minervini M, Nalesnik M A, Randhawa P, Wu T, Zeevi A, Abu-Elmagd K, Eghtesad B, Fontes P, Cacciarelli T, Marsh W, Geller D, Fung J J
Department of Pathology, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Transplantation. 2002 Nov 15;74(9):1290-6. doi: 10.1097/00007890-200211150-00016.
The Banff schema is the internationally accepted standard for grading acute liver-allograft rejection, but it has not been prospectively tested.
Complete Banff grading was prospectively applied to 2,038 liver-allograft biopsies from 901 adult tacrolimus-treated primary hepatic allograft recipients between August 1995 and September 2001. Histopathologic data was melded with demographic, clinical, and laboratory data into a database on an ongoing basis using locally developed software.
Acute rejection developed in 575 of 901 (64%) patients and the worst grade was mild in 422 of 575 (73%). At least one episode of moderate or severe acute rejection developed in 153 of 901 (17%) patients and most episodes, irrespective of severity, occurred within the first year after transplantation. Patients with moderate or severe acute rejection showed higher alanine aminotransferase (P =0.007) and aspartate aminotransferase ( P=0.07) levels and were more likely to develop perivenular fibrosis on follow-up biopsies (P =0.001) and graft failure from acute or chronic rejection ( P=0.004) than those with mild rejection. Regardless of severity, 80% of patients with acute rejection did not develop significant fibrosis in follow-up biopsies, and graft failure from acute or chronic rejection occurred in only 11 of 901 (1%) allografts.
Most acute-rejection episodes are mild and do not lead to clinically significant architectural sequelae. When tested prospectively under real-life and -time conditions, the Banff schema can be used to identify those few patients who are potentially at risk for more significant problems. Creation, capture, and integration of non-free text, or "digital," pathology data can be used to prospectively conduct outcomes-based research in transplantation.
班夫标准是国际上公认的急性肝移植排斥反应分级标准，但尚未进行前瞻性测试。
1995年8月至2001年9月期间，对901例接受他克莫司治疗的成年原发性肝移植受者的2038份肝移植活检标本进行了前瞻性的完整班夫分级。使用本地开发的软件，将组织病理学数据与人口统计学、临床和实验室数据持续整合到一个数据库中。
901例患者中有575例（64%）发生急性排斥反应，其中575例中有422例（73%）最严重分级为轻度。901例患者中有153例（17%）至少发生一次中度或重度急性排斥反应，且大多数发作，无论严重程度如何，均发生在移植后的第一年内。与轻度排斥反应患者相比，中度或重度急性排斥反应患者的丙氨酸转氨酶（P =0.007）和天冬氨酸转氨酶（P =0.07）水平更高，在随访活检中更易发生肝周纤维化（P =0.001），以及因急性或慢性排斥反应导致移植失败（P =0.004）。无论严重程度如何，80%的急性排斥反应患者在随访活检中未出现明显纤维化，901例移植中有11例（1%）因急性或慢性排斥反应导致移植失败。
大多数急性排斥反应发作是轻度的，不会导致临床上显著的结构后遗症。在现实生活和实时条件下进行前瞻性测试时，班夫标准可用于识别那些可能面临更严重问题风险的少数患者。非自由文本或“数字”病理数据的创建、采集和整合可用于前瞻性地开展移植领域基于结果的研究。
