Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
Mayo Clinic College of Medicine, Laboratory Medicine and Pathology, Rochester, Minnesota.
J Heart Lung Transplant. 2022 Oct;41(10):1487-1500. doi: 10.1016/j.healun.2022.06.021. Epub 2022 Jul 3.
Routine monitoring of lung-transplanted patients is crucial for the identification of immunological and non-immunological complications. Determining the etiology of acute allograft dysfunction, particularly in alloimmune-mediated disorders, relies heavily on the lung biopsy with histopathologic analysis. Standardization of the pathologic diagnosis of rejection (e.g., cellular and antibody-mediated) is based on consensus statements and guidelines, indicating the importance of a multidisciplinary approach to achieve a definitive etiological diagnosis. In addition to these statements and guidelines, refinements and standardizations are feasible through systematic analysis morphological, immunophenotypic and molecular alterations observed in transbronchial biopsies. This study is to identify key morphologic features to be assessed, select consistent and reproducible terminology for each histological feature, and provide standardized definitions for pathological assessment and grading.
A template was created by experts in lung transplantation including pathologists, pulmonologists, immunologists. An initial draft was circulated, followed by discussions and multiple revisions by email and conference calls.
The "lung allograft standardized histological analysis - LASHA" template was created and structured as multiple-choice questions with number of fields to be filled in to allow for standardization of results and easy transfer into a future electronic spreadsheet.
This template will help facilitate multicenter studies through a uniform protocol and correlations with new diagnostic modalities. After validation in large-scale studies, an optimized template could be included in routine clinical practice to enhance graft assessment and medical decision-making.
对肺移植患者进行常规监测对于识别免疫和非免疫并发症至关重要。确定急性移植物功能障碍的病因，特别是在同种免疫介导的疾病中，很大程度上依赖于肺活检和组织病理学分析。排斥反应（如细胞和抗体介导的）的病理诊断的标准化基于共识声明和指南，表明需要采用多学科方法来确定明确的病因诊断。除了这些声明和指南外，通过对经支气管活检中观察到的形态学、免疫表型和分子改变进行系统分析，还可以进行细化和标准化。本研究旨在确定需要评估的关键形态学特征，为每个组织学特征选择一致且可重复的术语，并为病理评估和分级提供标准化定义。
由肺移植领域的专家（包括病理学家、肺科医生和免疫学家）创建模板。首先起草一份模板，然后通过电子邮件和电话会议进行讨论和多次修订。
创建了“肺移植标准化组织学分析 - LASHA”模板，并将其构建为多项选择题，需要填写的字段数量可实现结果的标准化，并便于将来转换为电子电子表格。
该模板将通过统一的方案和与新诊断模式的相关性，有助于促进多中心研究。在大规模研究中验证后，优化后的模板可纳入常规临床实践，以增强对移植物的评估和医疗决策。
