Department of Pathology, University of Szeged, Allomas u. 2, 6720, Szeged, Hungary.
Virchows Arch. 2011 Sep;459(3):321-30. doi: 10.1007/s00428-011-1114-x. Epub 2011 Jul 1.
Marked peritubular capillary basement membrane (PTCBM) multilayering, the ultrastructural feature of chronic antibody-mediated rejection (ABMR) of kidney allografts, was found to correspond histologically to PTCs with thickened BMs; such PTCs have been suggested as a novel histological marker of chronic rejection. We investigated whether scoring of PTCBM thickening can substitute the ultrastructural search for PTCBM multilayering. The thickening was graded in PAS- and Jones-stained sections in 110 biopsies from recipients with a late dysfunction, all examined ultrastructurally for transplant capillaropathy (≥3 PTCs with ≥5 BM layers). Grade 0 indicated no thickening. Grade 1 and grade 2 were assigned when the PTCBMs were as thick as or thicker than those of the non-atrophic tubules, and duplication/chain-like lamination of the PTCBM was noted in ≤3 or ≥4 high-power fields, respectively. The series was enrolled in subgroups of those with and those without histopathological lesions of chronic rejection. Fifty-six biopsies displayed lesions of chronic ABMR. Transplant capillaropathy was demonstrated in 40 biopsies. Grade 2 thickening furnished a substantial interobserver concordance rate (κ = 0.803) and correlated with the transplant capillaropathy. Jones staining performed somewhat better in scoring than PAS staining. Grade 2 thickening was verified in 35 biopsies involving chronic ABMR, and in one control biopsy (sensitivity 61.4%, specificity 0.98). Grade 1 thickening was not suggestive of chronic ABMR at all. In conclusion, grade 2 thickening can be regarded as the histopathological lesion of chronic ABMR; however, electron microscopy remains the gold standard in the assessment of PTCBM changes.
明显的肾小管周毛细血管基底膜（PTCBM）多层化，是慢性抗体介导的排斥反应（ABMR）的肾移植的超微结构特征，与 PTCs 增厚的 BM 在组织学上相对应；这种 PTCs 被认为是慢性排斥的一种新的组织学标志物。我们研究了 PTCBM 增厚的评分是否可以替代 PTCBM 多层化的超微结构搜索。在 110 例晚期功能障碍受者的活检标本中，使用 PAS 和 Jones 染色对 PTCBM 增厚进行分级，所有标本均进行超微结构检查以评估移植毛细血管病（≥3 个 PTCs 有≥5 个 BM 层）。0 级表示无增厚。当 PTCBM 与非萎缩小管一样厚或更厚，并且 PTCBM 的复制/链状分层在≤3 个或≥4 个高倍视野中分别可见时，分别分配 1 级和 2 级。该系列分为有和没有慢性 ABMR 组织病理学病变的亚组。56 例活检显示慢性 ABMR 病变。40 例活检显示移植毛细血管病。2 级增厚提供了实质性的观察者间一致性率（κ=0.803），并且与移植毛细血管病相关。与 PAS 染色相比，Jones 染色在评分方面表现稍好。在涉及慢性 ABMR 的 35 例活检和 1 例对照活检中证实了 2 级增厚（敏感性 61.4%，特异性 0.98）。1 级增厚根本不能提示慢性 ABMR。总之，2 级增厚可被视为慢性 ABMR 的组织病理学病变；然而，电子显微镜仍然是评估 PTCBM 变化的金标准。
