de Kort Hanneke, Moran Linda, Roufosse Candice
aDepartment of Experimental Immunology bRenal Transplant Unit, Academic Medical Centre, Amsterdam, The Netherlands cElectron Microscopy Unit, Department of Histopathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital dDepartment of Cellular Pathology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
Curr Opin Organ Transplant. 2015 Jun;20(3):333-42. doi: 10.1097/MOT.0000000000000183.
To review and discuss the use of electron microscopy in the examination of renal transplant biopsies, in particular its role in the diagnosis of glomerular disease and antibody-mediated rejection.
Electron microscopy can detect recurrent and de-novo glomerular disease at early stages, in particular for focal and segmental glomerulosclerosis and thrombotic microangiopathy.Ultrastructural features are an integral part of the Banff definition of chronic, active antibody-mediated rejection, which has been recently modified to include ultrastructural-only glomerular double contours. In addition, the threshold of peritubular capillary basement membrane multilayering diagnostic for chronic, active antibody-mediated rejection has been changed. As an area for further investigation, ultrastructural-only glomerular and peritubular capillary features could become tools in the early detection of antibody-mediated rejection.
Electron microscopy is important in the diagnosis of glomerular disease and chronic, active antibody-mediated rejection, both of which contribute to late graft loss. Early detection and treatment may help prolong graft survival. More data are needed on the early ultrastructural features of antibody-mediated injury, so that the usefulness of this technique can be compared with emerging technologies such as transcript analysis.
回顾并讨论电子显微镜在肾移植活检检查中的应用，尤其是其在肾小球疾病诊断和抗体介导的排斥反应中的作用。
电子显微镜能够在早期检测复发性和新发的肾小球疾病，特别是局灶节段性肾小球硬化和血栓性微血管病。超微结构特征是慢性活动性抗体介导的排斥反应Banff定义的一个组成部分，该定义最近已修改，纳入了仅超微结构的肾小球双轮廓。此外，用于诊断慢性活动性抗体介导的排斥反应的肾小管周围毛细血管基底膜多层化阈值也已改变。作为一个有待进一步研究的领域，仅超微结构的肾小球和肾小管周围毛细血管特征可能成为早期检测抗体介导的排斥反应的工具。
电子显微镜在肾小球疾病和慢性活动性抗体介导的排斥反应的诊断中很重要，这两者都会导致移植肾晚期丢失。早期检测和治疗可能有助于延长移植肾存活时间。关于抗体介导损伤的早期超微结构特征，还需要更多数据，以便将该技术的实用性与转录分析等新兴技术进行比较。
