Stewart Susan, Fishbein Michael C, Snell Gregory I, Berry Gerald J, Boehler Annette, Burke Margaret M, Glanville Alan, Gould F Kate, Magro Cynthia, Marboe Charles C, McNeil Keith D, Reed Elaine F, Reinsmoen Nancy L, Scott John P, Studer Sean M, Tazelaar Henry D, Wallwork John L, Westall Glen, Zamora Martin R, Zeevi Adriana, Yousem Samuel A
Papworth Everard Pathology Department, Papworth Hospital, Cambridge, UK.
J Heart Lung Transplant. 2007 Dec;26(12):1229-42. doi: 10.1016/j.healun.2007.10.017.
In 1990, an international grading scheme for the grading of pulmonary allograft rejection was adopted by the International Society for Heart and Lung Transplantation (ISHLT) and was modified in 1995 by an expanded group of pathologists. The original and revised classifications have served the lung transplant community well, facilitating communication between transplant centers with regard to both patient management and research. In 2006, under the direction of the ISHLT, a multi-disciplinary review of the biopsy grading system was undertaken to update the scheme, address inconsistencies of use, and consider the current knowledge of antibody-mediated rejection in the lung. This article summarizes the revised consensus classification of lung allograft rejection. In brief, acute rejection is based on perivascular and interstitial mononuclear infiltrates, Grade A0 (none), Grade A1 (minimal), Grade A2 (mild), Grade A3 (moderate) and Grade A4 (severe), as previously. The revised (R) categories of small airways inflammation, lymphocytic bronchiolitis, are as follows: Grade B0 (none), Grade B1R (low grade, 1996, B1 and B2), Grade B2R (high grade, 1996, B3 and B4) and BX (ungradeable). Chronic rejection, obliterative bronchiolitis (Grade C), is described as present (C1) or absent (C0), without reference to presence of inflammatory activity. Chronic vascular rejection is unchanged as Grade D. Recommendations are made for the evaluation of antibody-mediated rejection, recognizing that this is a controversial entity in the lung, less well developed and understood than in other solid-organ grafts, and with no consensus reached on diagnostic features. Differential diagnoses of acute rejection, airway inflammation and chronic rejection are described and technical considerations revisited. This consensus revision of the working formulation was approved by the ISHLT board of directors in April 2007.
1990年，国际心肺移植学会（ISHLT）采用了一种肺移植排斥反应分级的国际分级方案，并于1995年由一组扩大的病理学家进行了修订。最初和修订后的分类为肺移植领域提供了很好的服务，促进了移植中心之间在患者管理和研究方面的交流。2006年，在ISHLT的指导下，对活检分级系统进行了多学科审查，以更新该方案，解决使用中的不一致问题，并考虑当前对肺中抗体介导排斥反应的认识。本文总结了修订后的肺移植排斥反应共识分类。简而言之，急性排斥反应基于血管周围和间质单核细胞浸润，分级为A0（无）、A1（轻度）、A2（中度）、A3（重度）和A4（极重度），与之前相同。小气道炎症、淋巴细胞性细支气管炎的修订（R）分类如下：B0（无）、B1R（低级别，1996年的B1和B2）、B2R（高级别，1996年的B3和B4）和BX（无法分级）。慢性排斥反应，闭塞性细支气管炎（C级），描述为存在（C1）或不存在（C0），不考虑炎症活动的存在。慢性血管排斥反应不变，仍为D级。针对抗体介导排斥反应的评估提出了建议，认识到这在肺中是一个有争议的实体，其发展和理解程度不如其他实体器官移植，并且在诊断特征上尚未达成共识。描述了急性排斥反应、气道炎症和慢性排斥反应的鉴别诊断，并重新审视了技术考虑因素。该工作方案的这一共识修订版于2007年4月获得ISHLT董事会批准。
