修订版班夫标准在抗体介导性排斥反应诊断中的临床意义

Clinical Significance of Revised Banff Criteria in the Diagnosis of Antibody-Mediated Rejection.

作者信息

Jeong Hyang Sook, Kim Deok Gie, Lee Seung-Tae, Huh Kyu Ha, Kim Yu Seun, Jeong Hyeon Joo, Lim Beom Jin

机构信息

Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Transplant Proc. 2019 Jun;51(5):1488-1490. doi: 10.1016/j.transproceed.2019.03.012. Epub 2019 Apr 30.

DOI:10.1016/j.transproceed.2019.03.012

PMID:31053345

Abstract

BACKGROUND

The diagnostic criteria of antibody-mediated rejection (ABMR) has been significantly changed since Banff 2013. The most important revision was adopting microvascular inflammation (MVI) as immunopathologic evidence for ABMR even in C4d-negative cases. In this study, we retrospectively reviewed previous allograft biopsy results and evaluated the impact of this change.

METHODS

We reviewed results of 536 renal allograft biopsies at Severance Hospital during 2011 to 2013, which were diagnosed according to the Banff 2009 criteria. All biopsy results were reassessed according to the Banff 2017 criteria.

RESULTS

According to the Banff 2009 criteria, antibody-mediated changes were observed in 48 cases out of the 536 allograft biopsies (9.0%). According to the Banff 2017 criteria, 28 additional cases (5.2%) were reclassified as antibody-mediated changes. Twenty-six of these cases were C4d-negative ABMR. The most frequent diagnostic finding in these cases was MVI comprising glomerulitis and peritubular capillaritis. Donor-specific antibodies were investigated in 14 of these cases, which revealed positive results in 12 cases.

CONCLUSION

The incidence rate of ABMR has increased after the recent revision of the Banff criteria. The MVI in C4d-negative ABMR cases is the major cause for this increase.

摘要

背景

自2013年班夫标准以来，抗体介导性排斥反应（ABMR）的诊断标准发生了显著变化。最重要的修订是将微血管炎症（MVI）作为ABMR的免疫病理学证据，即使在C4d阴性病例中也是如此。在本研究中，我们回顾了既往同种异体移植活检结果，并评估了这一变化的影响。

方法

我们回顾了2011年至2013年期间首尔圣母医院536例肾移植活检的结果，这些结果是根据2009年班夫标准诊断的。所有活检结果均根据2017年班夫标准重新评估。

结果

根据2009年班夫标准，在536例同种异体移植活检中，有48例（9.0%）观察到抗体介导的变化。根据2017年班夫标准，另外28例（5.2%）被重新分类为抗体介导的变化。其中26例为C4d阴性ABMR。这些病例中最常见的诊断发现是由肾小球炎和肾小管周围毛细血管炎组成的MVI。在其中14例病例中检测了供者特异性抗体，其中12例结果呈阳性。