Aita Kumi, Yamaguchi Yutaka, Horita Shigeru, Ohno Mayuko, Tanabe Kazunari, Fuchinoue Shouhei, Teraoka Satoshi, Toma Hiroshi
Molecular Pathology, Institute of Basic Medical Science, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukubashi, Ibaraki, Japan.
Clin Transplant. 2005;19 Suppl 14:20-6. doi: 10.1111/j.1399-0012.2005.00400.x.
Peritubular capillaritis (PTCitis) has been recognized as one form of acute/active allograft rejection, and its relation to humoral immunity has been suggested. However, its mechanisms remain to be fully clarified, and there are no criteria for evaluating the extent of PTCitis in a biopsied allograft. In this study, we first evaluated the extent of PTCitis in early allografts in patients presenting with acute cellular rejection (ACR) and antibody-mediated rejection (AbAR). We also included patients who showed no evidence of ACR and/or AbAR. Next, we investigated whether or not PTCitis persisted and if peritubular capillary basement membrane (PTCBM) thickening was present in their follow-up biopsy specimens. We adopted the scoring system of PTCitis, which was presented at the Seventh Banff Conference on Allograft Pathology in 2003. In total, 53 patients were included in this study. At first biopsy, 17 showed ACR, eight showed AbAR, 16 showed mild PTCitis only, and 14 were without significant pathologic changes. The PTC score was the highest in the AbAR group, and in some patients the score gradually increased during the follow-up period. Similar changes were also observed in the group with mild PTCitis only. In late allografts, half of the patients with AbAR developed chronic rejection (CR), and the PTCBM score was the highest in that group. Surprisingly, CR was present in more than 30% of patients without ACR and/or AbAR but mild PTCitis only. In the control group, only a few showed CR and/or chronic allograft nephropathy (CAN). In conclusion, it became clear that we should carefully monitor for mild PTCitis in early allografts. In addition, our data also proved the usefulness of the PTC score and PTCBM score.
肾小管周围毛细血管炎（PTC炎）已被确认为急性/活动性同种异体移植排斥反应的一种形式，并且有人提出了其与体液免疫的关系。然而，其机制仍有待充分阐明，并且在活检的同种异体移植中尚无评估PTC炎程度的标准。在本研究中，我们首先评估了出现急性细胞排斥反应（ACR）和抗体介导的排斥反应（AbAR）的患者早期同种异体移植中PTC炎的程度。我们还纳入了未显示ACR和/或AbAR证据的患者。接下来，我们调查了PTC炎是否持续存在以及在其随访活检标本中是否存在肾小管周围毛细血管基底膜（PTCBM）增厚。我们采用了2003年第七届班夫同种异体移植病理学会议上提出的PTC炎评分系统。本研究共纳入53例患者。在首次活检时，17例显示ACR，8例显示AbAR，16例仅显示轻度PTC炎，14例无明显病理变化。PTC评分在AbAR组中最高，并且在一些患者中，该评分在随访期间逐渐升高。仅轻度PTC炎组也观察到了类似变化。在晚期同种异体移植中，一半的AbAR患者发生了慢性排斥反应（CR），并且该组中PTCBM评分最高。令人惊讶的是，超过30%无ACR和/或AbAR但仅轻度PTC炎的患者出现了CR。在对照组中，只有少数患者出现CR和/或慢性同种异体移植肾病（CAN）。总之，很明显我们应该在早期同种异体移植中仔细监测轻度PTC炎。此外，我们的数据也证明了PTC评分和PTCBM评分的有用性。
