Demetris A J, Seaberg E C, Batts K P, Ferrell L D, Ludwig J, Markin R S, Belle S H, Detre K
Department of Pathology, University of Pittsburgh, PA 15213.
Hepatology. 1995 Feb;21(2):408-16.
Pathologists participating in the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplant Database (LTD) created a histopathological grading system for acute liver allograft rejection, and tested it first for inter- and intra-rater reliability among a group of five pathologists experienced in liver and transplantation pathology. Specimens from post-transplantation biopsies from 48 patients with rejection, hepatitis, or other diagnosis(es) were reviewed. There was moderate to good (kappa = 0.40 to 0.55) inter-rater and good (kappa = 0.55 to 0.58) intrarater agreement for the diagnosis and exact grading of mild, moderate, or severe acute rejection, which improved when a short clinical history was provided. Thus, the scheme was reproducible, and few of the disagreements among the pathologists would have affected treatment decisions. Secondly, the ability of the grading system to predict an unfavorable short- or long-term outcome from the initial histopathological diagnosis of cellular rejection was tested on groups of 168 and 133 patients, respectively, from the three LTD clinical centers, who were followed up for at least 6 months after the first onset of rejection. This analysis showed that a higher histopathological grade of acute rejection on first biopsy diagnosis was significantly associated (P < or = .006) with both an unfavorable short-term outcome, defined by failure of the episode to resolve within 21 days or the need for aggressive immunosuppressive treatment, and a long-term outcome defined by death or retransplantation from rejection within 6 months of onset. Lastly, an analysis was performed to determine whether subjective rejection grading by the pathologist or certain "objective" histopathological features identified by logistic regression modeling were more accurate in predicting an unfavorable outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
参与美国国立糖尿病、消化和肾脏疾病研究所肝脏移植数据库（LTD）的病理学家创建了一种急性肝移植排斥反应的组织病理学分级系统，并首先在一组五名有肝脏和移植病理学经验的病理学家中测试了该系统在评分者间和评分者内的可靠性。回顾了48例有排斥反应、肝炎或其他诊断的移植后活检标本。对于轻度、中度或重度急性排斥反应的诊断和精确分级，评分者间一致性为中度至良好（kappa = 0.40至0.55），评分者内一致性良好（kappa = 0.55至0.58），当提供简短临床病史时一致性有所提高。因此，该方案具有可重复性，病理学家之间的分歧很少会影响治疗决策。其次，分别在来自LTD三个临床中心的168例和133例患者组中测试了分级系统从细胞排斥反应的初始组织病理学诊断预测不良短期或长期结果的能力，这些患者在首次出现排斥反应后至少随访6个月。该分析表明，首次活检诊断时急性排斥反应的组织病理学分级较高与不良短期结果（定义为发作在21天内未缓解或需要积极免疫抑制治疗）和不良长期结果（定义为在发病6个月内死于排斥反应或再次移植）均显著相关（P≤0.006）。最后，进行了一项分析，以确定病理学家的主观排斥反应分级或逻辑回归模型确定的某些“客观”组织病理学特征在预测不良结果方面是否更准确。（摘要截短于250字）
