Varol Hilal, Wagenmakers Anne, Hoeft Konrad, Callemeyn Jasper, Bodewes Roos, Bramer Wichor, Stubbs Andrew, Kramann Rafael, Naesens Maarten, Clahsen-Van Groningen Marian C
Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands.
Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands.
Transpl Int. 2025 Jan 6;37:13464. doi: 10.3389/ti.2024.13464. eCollection 2024.
Microvascular inflammation (MVI) in kidney transplant biopsies is mainly associated with antibody-mediated rejection (AMR), sparking debate within the Banff Classification of Renal Allograft Pathology regarding its exclusivity. This study reviewed the literature on MVI in T cell-mediated rejection (TCMR) and analyzed MVI in our transplant population. We searched English publications in MEDLINE, Embase, Web of Science, Cochrane, and Google Scholar until June 2024, focusing on glomerulitis (g), peritubular capillaritis (ptc), or MVI in kidney transplant biopsies classified as TCMR. Additionally, we examined g, ptc, and MVI in 69 patients with AMR, TCMR, and no rejection. Our search yielded 541 citations, with 10 studies included, covering 810 TCMR and 156 AMR biopsies. The studies showed g, ptc, and MVI were present in TCMR but were less prevalent and severe than in AMR. In our cohort, AMR had significantly higher g, ptc, and MVI scores compared to aTCMR and ATN, however, aTCMR also displayed MVI. These findings confirm that MVI occurs in aTCMR and should not be exclusively linked to AMR. These findings highlight the need to further explore MVI's significance in TCMR and investigate the inflammatory composition. This could refine the Banff Classification, improving Classification accuracy of kidney transplant pathology assessments.
肾移植活检中的微血管炎症（MVI）主要与抗体介导的排斥反应（AMR）相关，这在肾移植病理的班夫分类中引发了关于其排他性的争论。本研究回顾了关于T细胞介导的排斥反应（TCMR）中MVI的文献，并分析了我们移植人群中的MVI。我们检索了截至2024年6月在MEDLINE、Embase、科学网、Cochrane和谷歌学术上的英文出版物，重点关注肾移植活检中分类为TCMR的肾小球炎（g）、肾小管周围毛细血管炎（ptc）或MVI。此外，我们检查了69例发生AMR、TCMR和无排斥反应患者的g、ptc和MVI。我们的检索产生了541条引用，纳入了10项研究，涵盖810例TCMR活检和156例AMR活检。研究表明，g、ptc和MVI在TCMR中存在，但比在AMR中更不常见且严重程度更低。在我们的队列中，与急性TCMR和急性肾小管坏死相比，AMR的g、ptc和MVI评分显著更高，然而，急性TCMR也表现出MVI。这些发现证实MVI发生在急性TCMR中，不应仅与AMR相关联。这些发现强调需要进一步探索MVI在TCMR中的意义并研究炎症成分。这可以完善班夫分类，提高肾移植病理评估的分类准确性。
