Morozumi K, Fukuda M, Takeda A
Division of Hemodialysis, Nagoya City University, School of Medicine.
Hinyokika Kiyo. 1998 May;44(5):353-7.
The topics of renal allograft pathology; validation of the Banff classification and a new criterion for chronic rejection are reviewed. Although the clinico-pathologic utility of the Banff classification is remarkably high in acute rejection, the Banff scheme is still incomplete. The severity of rejection based on the Banff schema well correlated with the deterioration of graft function and also with reversibility of the graft function. Grade III acute rejection in the Banff schema suggested poor graft function, while grade IIb acute rejection could be cured by rejection therapy in the CyA era. The morphological characteristics of chronic rejections in renal allografts become milder and less specific in the CyA era. The differentiation of chronic rejection of immunologic origin from other conditions leading to renal scarring remains one of the major problems in renal allograft biopsy interpretation. Chronic CyA nephrotoxicity and/or glomerulonephritis frequently accompany chronic rejection. Electron microscopic peritubular capillary basement membrane lesion (MSPTC) was a sensitive indicator for chronic rejection of immunologic origin as well as glomerular capillary lesions. The negative MSPTC in the patients with chronic rejection suggest that the deterioration of the graft function is probably non-immunologic in origin.
本文综述了同种异体肾移植病理学的主题、班夫分类法的验证以及慢性排斥反应的新标准。尽管班夫分类法在急性排斥反应中的临床病理实用性非常高，但该方案仍不完整。基于班夫模式的排斥反应严重程度与移植肾功能恶化以及移植肾功能的可逆性密切相关。班夫模式中的III级急性排斥反应提示移植肾功能不佳，而IIb级急性排斥反应在环孢素时代可通过抗排斥治疗治愈。在环孢素时代，同种异体肾移植慢性排斥反应的形态学特征变得更轻微且特异性更低。将免疫源性慢性排斥反应与导致肾瘢痕形成的其他情况区分开来仍然是同种异体肾移植活检解读中的主要问题之一。慢性环孢素肾毒性和/或肾小球肾炎常伴随慢性排斥反应。电子显微镜下肾小管周围毛细血管基底膜病变（MSPTC）是免疫源性慢性排斥反应以及肾小球毛细血管病变的敏感指标。慢性排斥反应患者中MSPTC阴性提示移植肾功能恶化可能是非免疫源性的。
