Sakai Ken, Oguchi Hideyo, Muramatsu Masaki, Shishido Seiichiro
Department of Nephrology, Faculty of Medicine, Toho University, Tokyo, Japan.
Nephrology (Carlton). 2018 Jul;23 Suppl 2:38-44. doi: 10.1111/nep.13282.
Accurate interpretation of renal allograft biopsy is necessary to guide therapy, especially when an episode biopsy is taken to rescue the graft. Contrarily, a protocol biopsy is carried out routinely to identify baseline conditions (biopsy at 0 or 1 h), subclinical rejection, histological change under current immunosuppression regimen, drug nephrotoxicity, viral infection, and recurrence of glomerulonephritis. Semiquantitative scoring for active lesions including tubulitis, glomerulitis, capillaritis, arteritis, arteriopathy, and others such as polyomavirus infection are key factors in transplant pathology. Recently, the Banff classification has proposed several novel concepts focused on antibody-mediated rejection (ABMR). This review presents the interpretation of transplant pathology from rejection to infection, recurrence of glomerulonephritis, and drug nephrotoxicity, with a description of ABMR according to the 2013 and 2017 Banff classification.
准确解读肾移植活检对于指导治疗至关重要，尤其是在进行穿刺活检以挽救移植肾时。相反，方案活检是常规进行的，以确定基线情况（0或1小时时的活检）、亚临床排斥反应、当前免疫抑制方案下的组织学变化、药物肾毒性、病毒感染以及肾小球肾炎的复发。对包括肾小管炎、肾小球炎、毛细血管炎、动脉炎、动脉病变等活动性病变以及其他如多瘤病毒感染进行半定量评分是移植病理学的关键因素。最近，班夫分类法提出了几个侧重于抗体介导排斥反应（ABMR）的新概念。本文综述了从排斥反应到感染、肾小球肾炎复发以及药物肾毒性的移植病理学解读，并根据2013年和2017年班夫分类法对ABMR进行了描述。
