Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Nephron. 2023;147 Suppl 1:74-79. doi: 10.1159/000530158. Epub 2023 Mar 16.
The three primary sites of acute T-cell-mediated rejection (TCMR) in transplanted kidneys are the tubular epithelial cells, interstitium, and the vascular endothelial cells. The pathology of acute lesions is characterized by inflammatory cell infiltration; the final diagnosis suggested by the Banff 2019 classification is guided by grading of tubulitis (the t score), interstitial inflammation (the i score), and endarteritis (the v score). Consistent major issues when using the Banff classification are the etiological classifications of interstitial fibrosis and tubular atrophy (IFTA). From 2015 to 2019, technological advances (i.e., genetic analysis in paraffin sections) increased our understanding of IFTA status in patients with smoldering acute TCMR and the roles played by inflammatory cell infiltration (the i-IFTA score) and tubulitis (the t-IFTA score) in IFTA. These two scores were introduced when establishing the diagnostic criteria for chronic active TCMR. Despite the increase in complexity and the lack of a consensus treatment for chronic active TCMR, the Banff classification may evolve as new techniques (i.e., genetic analysis in paraffin sections and deep learning of renal pathology) are introduced. The Banff conference proceeded as follows. First, lesions were defined. Next, working groups were established to better understand the lesions and to derive better classification methods. Finally, the new Banff classification was developed. This approach will continue to evolve; the Banff classification will become a very useful diagnostic standard. This paper overviews the history of TCMR diagnosis using the Banff classification, and the clinical importance, treatment, and prospects for acute and chronic active TCMR.
急性 T 细胞介导排斥反应（TCMR）在移植肾脏中的三个主要部位是肾小管上皮细胞、间质和血管内皮细胞。急性病变的病理学特征是炎症细胞浸润；Banff 2019 分类建议的最终诊断由 tubulitis（t 评分）、间质炎症（i 评分）和动脉内膜炎（v 评分）的分级指导。使用 Banff 分类时的一致主要问题是间质纤维化和肾小管萎缩（IFTA）的病因分类。从 2015 年到 2019 年，技术进步（即石蜡切片中的基因分析）增加了我们对隐匿性急性 TCMR 患者 IFTA 状态以及炎症细胞浸润（i-IFTA 评分）和 tubulitis（t-IFTA 评分）在 IFTA 中的作用的理解。这两个评分在建立慢性活动性 TCMR 的诊断标准时引入。尽管慢性活动性 TCMR 的复杂性增加且缺乏共识治疗方法，但随着新技术（即石蜡切片中的基因分析和肾脏病理学的深度学习）的引入，Banff 分类可能会不断发展。Banff 会议的进行方式如下。首先，定义了病变。其次，成立了工作组，以更好地了解病变并开发更好的分类方法。最后，制定了新的 Banff 分类。这种方法将继续发展；Banff 分类将成为一个非常有用的诊断标准。本文综述了使用 Banff 分类诊断 TCMR 的历史，以及急性和慢性活动性 TCMR 的临床重要性、治疗和前景。
