William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.
Baylor University Medical Center, Dallas, TX, USA.
Transpl Int. 2021 Mar;34(3):488-498. doi: 10.1111/tri.13813.
The Banff antibody-mediated rejection (ABMR) classification is vulnerable to misinterpretation, but the reasons are unclear. To better understand this vulnerability, we evaluated how ABMR is diagnosed in practice. To do this, the Banff Antibody-Mediated Injury Workgroup electronically surveyed an international cohort of nephrologists/surgeons (n = 133) and renal pathologists (n = 99). Most providers (97%) responded that they use the Banff ABMR classification at least sometimes, but DSA information is often not readily available. Only 41.1% (55/133) of nephrologists/surgeons and 19.2% (19/99) of pathologists reported that they always have DSA results when the biopsy is available. Additionally, only 19.6% (26/133) of nephrologists/surgeons responded that non-HLA antibody or molecular transcripts are obtained when ABMR histologic features are present but DSA is undetected. Several respondents agreed that histologic features concerning for ABMR in the absence of DSA and/or C4d are not well accounted for in the current classification [31.3% (31/99) pathologists and 37.6% (50/133) nephrologist/surgeons]. The Banff ABMR classification appears widely accepted, but efforts to improve the accessibility of DSA information for the multidisciplinary care team are needed. Further clarity is also needed in Banff ABMR nomenclature to account for the spectrum of ABMR and for histologic features suspicious for ABMR when DSA is absent.
Banff 抗体介导的排斥反应 (ABMR) 分类容易产生误解，但原因尚不清楚。为了更好地理解这种脆弱性，我们评估了 ABMR 在实践中的诊断情况。为此，Banff 抗体介导的损伤工作组通过电子邮件向国际肾脏病专家/外科医生（n=133）和肾脏病理学家（n=99）进行了调查。大多数医生（97%）表示他们至少有时会使用 Banff ABMR 分类，但 DSA 信息通常不容易获得。只有 41.1%（55/133）的肾脏病专家/外科医生和 19.2%（19/99）的病理学家报告说，当活检可用时，他们总是有 DSA 结果。此外，只有 19.6%（26/133）的肾脏病专家/外科医生表示，当存在 ABMR 组织学特征但未检测到 DSA 时，他们会获得非 HLA 抗体或分子转录本。一些受访者同意，在没有 DSA 和/或 C4d 的情况下，当前分类未能很好地考虑到与 ABMR 相关的组织学特征[31.3%（99 名病理学家中的 31 名）和 37.6%（133 名肾脏病专家/外科医生中的 50 名）]。Banff ABMR 分类似乎得到了广泛的认可，但需要努力改善 DSA 信息的获取，以满足多学科护理团队的需求。还需要进一步澄清 Banff ABMR 命名法，以说明 ABMR 的范围，以及在没有 DSA 时，组织学特征对 ABMR 的怀疑。
