Casey Edward T, Smyrk Thomas C, Burgart Lawrence J, Stegall Mark D, Larson Timothy S
Division of Nephrology and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Transplantation. 2005 Jun 27;79(12):1717-22. doi: 10.1097/01.tp.0000159148.13431.d0.
The most widely used grading scheme for acute pancreas allograft rejection grades biopsy specimens from 0 (normal) to V (severe rejection). Although the more advanced grades correlate strongly with immunologic graft loss, it is unclear how lesser grades impact graft outcome. The authors therefore report the outcomes of untreated grade II (minimal) rejection of solitary pancreas biopsy specimens.
The authors retrospectively analyzed all solitary pancreas transplants performed at the Mayo Clinic between January 2001 and November 2002. The authors selected all patients who were found with grade II findings on biopsy. Whether patients underwent follow-up biopsies, what the results were, and graft survival at the end of the study period were then determined.
A total of 88 pancreas transplants were performed; 20 pancreas transplant recipients (23%) developed grade II (minimal) rejection and were followed for a mean of 22.8+/-8.7 months. Eighteen patients underwent biopsy for protocol purposes and two patients underwent clinically indicated biopsies. Of the patients who underwent biopsy as per protocol, 15 of the patients had a total of 25 follow-up biopsies: 10 were grade 0; 3 were grade I; and 10 were unchanged (grade II). Rejection in one patient progressed to grade III and in another patient to grade IV. The three patients who did not undergo repeat biopsy had a functioning allograft pancreas at the end of the study period. Of the two patients with grade II biopsy specimens obtained for clinical reasons, one had resolution of all inflammation noted on three follow-up biopsies, and the other patient did not undergo follow-up biopsy and died with a functioning graft.
Grade II (minimal) rejection of solitary pancreas allograft rarely progresses to more severe degrees of inflammation. Morphologic findings in this category may not have unfavorable prognoses over a period of 2 years when untreated.
急性胰腺移植排斥反应最广泛使用的分级方案将活检标本分为0级（正常）至V级（严重排斥）。虽然更高级别的排斥与免疫性移植物丢失密切相关，但较低级别如何影响移植物结局尚不清楚。因此，作者报告了孤立胰腺活检标本未经治疗的II级（轻度）排斥反应的结局。
作者回顾性分析了2001年1月至2002年11月在梅奥诊所进行的所有孤立胰腺移植。作者选择了所有活检发现II级病变的患者。然后确定患者是否接受了随访活检、结果如何以及研究期末的移植物存活情况。
共进行了88例胰腺移植；20例胰腺移植受者（23%）发生了II级（轻度）排斥反应，并平均随访了22.8±8.7个月。18例患者因方案要求接受了活检，2例患者接受了临床指征的活检。在按方案接受活检的患者中，15例患者共进行了25次随访活检：10例为0级；3例为I级；10例无变化（II级）。1例患者的排斥反应进展为III级，另1例患者进展为IV级。3例未接受重复活检的患者在研究期末有一个功能正常的移植胰腺。在因临床原因获得II级活检标本的2例患者中，1例在3次随访活检中所有炎症均消退，另1例患者未接受随访活检，死亡时移植物功能正常。
孤立胰腺移植的II级（轻度）排斥反应很少进展为更严重的炎症程度。未经治疗时，此类形态学表现2年内可能没有不良预后。
