Corey H E, Greenstein S M, Tellis V, Schechner R, Greifer I, Bennett B
Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, New York 10461, USA.
Pediatr Nephrol. 1995 Jun;9(3):309-12. doi: 10.1007/BF02254194.
In the Banff classification, arteritis and tubulitis are regarded as the principal histological lesions indicating acute renal allograft rejection. To test this claim, we examined 51 biopsies obtained from 21 children and young adults with transplant rejection. Two reviewers, blind to the clinical course, graded the biopsies according to the Banff scheme. In patients without significant tubulitis (borderline changes), rejection tended to be reversed easily (88%), often with methylprednisolone pulse (52%). In patients with arteritis or significant tubulitis (Banff I-III), rejection was reversed in only 23% (P < 0.001), in 9% with steroids, and in 14% with OKT3. Salvage of the graft was achieved in 26 of 35 (74%) with a score < 5 but in only 1 of 12 (8%) with a score > or = 5 (P < 0.001). All 6 patients with vasculitis lost their grafts despite methylprednisolone pulse and OKT3. We conclude that the Banff classification predicts accurately the outcome of renal allograft rejection in children and may aid in choosing appropriate therapy.
在班夫分类中，动脉炎和肾小管炎被视为提示急性肾移植排斥反应的主要组织学病变。为验证这一说法，我们检查了从21名患有移植排斥反应的儿童和年轻成人身上获取的51份活检样本。两名对临床病程不知情的评审员根据班夫方案对活检样本进行分级。在没有明显肾小管炎（临界变化）的患者中，排斥反应往往容易逆转（88%），通常使用甲泼尼龙冲击治疗（52%）。在患有动脉炎或明显肾小管炎（班夫I - III级）的患者中，排斥反应仅在23%的患者中逆转（P < 0.001），9%的患者使用类固醇逆转，14%的患者使用OKT3逆转。评分 < 5的35名患者中有26名（74%）成功挽救了移植肾，但评分≥5的12名患者中只有1名（8%）成功挽救（P < 0.001）。尽管使用了甲泼尼龙冲击治疗和OKT3，所有6名患有血管炎的患者均失去了移植肾。我们得出结论，班夫分类能够准确预测儿童肾移植排斥反应的结果，并可能有助于选择合适的治疗方法。
