Department of Diagnostic Pathology, Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan.
Nephron. 2023;147 Suppl 1:67-73. doi: 10.1159/000531575. Epub 2023 Aug 11.
Antibody-mediated rejection (ABMR), T-cell-mediated rejection (TCMR), BK polyomavirus nephropathy, and calcineurin inhibitor (CNI) toxicity are all common causes of kidney allograft dysfunction that can affect long-term allograft function.
The prevalence of various pathological diagnoses changes over time for both indication and protocol biopsies. Active ABMR and CNI toxic tubulopathy are the leading causes of kidney allograft dysfunction in the early posttransplant period. Active ABMR can also manifest as thrombotic microangiopathy. Acute TCMR, borderline for acute TCMR, and BK polyomavirus nephropathy will occur, then comes a causal peak of renal allograft dysfunction, followed by chronic active ABMR. Active ABMR in the late posttransplant period would progress to chronic active ABMR, indicating sequential evolution from the incipient to advanced phase of chronic active ABMR. CNI toxicity also manifests as chronic lesions of arteriolar hyalinosis. Interstitial fibrosis and tubular atrophy are the result of multiple insults and are linked to underlying diseases, particularly in the late posttransplant period. Even with established pathological criteria of the Banff scheme, it can be still challenging to clearly delineate the causes of the allograft dysfunction, especially in the complicated cases. Understanding the chronological causes of renal allograft dysfunctions improves comprehension of renal allograft pathology.
Identifying the time-dependent prevalence of renal allograft dysfunction can be a critical and effective approach to pathological diagnosis.
抗体介导的排斥反应（ABMR）、T 细胞介导的排斥反应（TCMR）、BK 多瘤病毒肾病和钙调神经磷酸酶抑制剂（CNI）毒性都是导致肾移植功能障碍的常见原因，会影响长期移植物功能。
无论是适应证活检还是方案活检，各种病理诊断的流行率随时间而变化。在移植后早期，活跃的 ABMR 和 CNI 毒性肾小管病是导致肾移植功能障碍的主要原因。活跃的 ABMR 也可能表现为血栓性微血管病。急性 TCMR、急性 TCMR 边界和 BK 多瘤病毒肾病将会发生，随后是导致肾移植功能障碍的因果高峰，然后是慢性活跃 ABMR。移植后晚期的活跃 ABMR 会进展为慢性活跃 ABMR，表明从慢性活跃 ABMR 的初始阶段到晚期阶段的连续演变。CNI 毒性也表现为细动脉玻璃样变的慢性病变。间质纤维化和肾小管萎缩是多种损伤的结果，与基础疾病有关，尤其是在移植后晚期。即使有 Banff 方案的既定病理标准，仍然难以明确界定移植物功能障碍的原因，尤其是在复杂病例中。了解肾移植功能障碍的时间依赖性病因有助于理解肾移植病理学。
确定肾移植功能障碍的时间依赖性流行率可能是病理诊断的一种关键且有效的方法。
