Tsamandas A C, Shapiro R, Jordan M, Demetris A J, Randhawa P S
Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Clin Transplant. 1997 Apr;11(2):139-41.
Tubulitis is the principal lesion used for the diagnosis of acute rejection (AR) in the Banff schema for renal allograft pathology. It is considered to be reliable for assessing AR early after transplantation. However, its significance in biopsies with concurrent changes of chronic allograft nephropathy (CAN) is less well understood. To address this issue we studied seventeen allograft biopsies taken 9-108 (median 39) months post-transplant from 17 patients. All specimens were scored for AR and CAN using Banff criteria. Medical records were reviewed to determine the clinical course of the patients. Five biopsies showed t1 changes, whereas nine biopsies graded as t2, and three biopsies as t3. The CAN scores varied from cg0, ci1, ct1, cv1, to cg1, ci3, ct3, cv3. A response to increased immunosuppression, defined as a fall in the serum creatinine of at least 20% compared to the peak value, was observed in 7/17 (41%) cases. The responsive cases included 2/5, 4/9, and 1/3 cases respectively with t1, t2, and t3 tubulitis. The mean +/- SD CAN scores in these three groups were 8.4 +/- 1.8, 6.5 +/- 1.4, and 7.0 +/- 1.4, respectively. We conclude that the presence of coexisting tubulitis and CAN in renal allograft biopsies may indicate reversible acute rejection. In this study, clinical response was observed in 7/17 (41%) patients. Patients with therapeutically responsive rejection could not be differentiated from refractory cases by serum creatinine, tubulitis grade, per cent glomerulosclerosis and sum scores for AR or CAN. Hence a trial of anti-rejection therapy may be warranted pre-emptively in all such cases.
肾小管炎是肾移植病理Banff分类法中用于诊断急性排斥反应（AR）的主要病变。它被认为在评估移植后早期的AR方面是可靠的。然而，其在同时伴有慢性移植肾肾病（CAN）改变的活检中的意义尚不太清楚。为解决这一问题，我们研究了17例患者移植后9 - 108（中位数39）个月的17份移植肾活检标本。所有标本均按照Banff标准对AR和CAN进行评分。查阅病历以确定患者的临床病程。5份活检显示t1改变，9份活检分级为t2，3份活检为t3。CAN评分从cg0、ci1、ct1、cv1到cg1、ci3、ct3、cv3不等。17例中有7例（41%）观察到对增加免疫抑制治疗有反应，定义为血清肌酐较峰值下降至少20%。有反应的病例中，t1、t2和t3级肾小管炎分别有2/5、4/9和1/3例。这三组的平均±标准差CAN评分分别为8.4±1.8、6.5±1.4和7.0±1.4。我们得出结论，肾移植活检中同时存在肾小管炎和CAN可能提示可逆性急性排斥反应。在本研究中，17例患者中有7例（41%）观察到临床反应。血清肌酐、肾小管炎分级、肾小球硬化百分比以及AR或CAN的总分不能区分治疗反应性排斥患者和难治性病例。因此，对于所有此类病例，可能有必要预先进行抗排斥治疗试验。
