移植肾抗体介导的排斥反应:Banff诊断标准更新

Diagnosis of antibody mediated rejection in renal allografts: the evolving criteria

近20年来对移植肾抗体介导的排斥反应(ABMR)认识逐渐深入。2001年和2007年的Banff会议,最早制订了急性和慢性活动性ABMR的诊断标准,由组织学(微血管炎症和移植肾肾小球病)、免疫病理(管周毛细血管C4d沉积)和血清学[循环中检出供者特异性抗体(DSA)]三方面的依据,构成ABMR的确定性诊断。Banff 2013诊断标准提出了较大更新,引入了C4d阴性的ABMR,并将动脉内膜炎列入ABMR可能的潜在表现,同时修订了肾小球炎和移植肾肾小球病的定义,从而提高了观察者之间的一致性,促进了临床、分子和血清学诊断的联系。Banff 2017会议,对诊断标准又有了更新,将C4d和分子分类器明确为DSA的替代性标志物。本文就近20年来ABMR Banff诊断标准的更新做一概述。

During the past two decades,there has developed an increasing awareness of antibody-mediated rejection(ABMR).The original Banff schema for diagnosis of acute and chronic active ABMR in renal allografts was formulated at the 2001 and 2007 Banff Conferences,and required histologic(microvascular inflammation and transplant glomerulopathy),immunohistologic(C4 d in peritubular capillaries),and serologic [circulating donor-specific antibodies(DSA)] evidence for a definitive diagnosis.This schema was updated at the 2013 Banff Conference,recognizing C4 d-negative ABMR,intimal arteritis as a potential manifestation of ABMR,and revising definitions and thresholds for glomerulitis and transplant glomerulopathy.At the 2017 Banff Conference,new modifications were made,accepting C4 d and thoroughly validated molecular classifiers as surrogate markers for DSA.