RENAL-ALLOGRAFT REJECTION IN CHILDREN AND YOUNG-ADULTS - THE BANFF CLASSIFICATION

被引：8

作者：

COREY, HE

GREENSTEIN, SM

TELLIS, V

SCHECHNER, R

GREIFER, I

BENNETT, B

机构：

[1] Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, 10461, New York

[2] Department Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, 10461, New York

[3] Department Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, 10461, New York

来源：

PEDIATRIC NEPHROLOGY | 1995年 / 9卷 / 03期

关键词：

REJECTION; TUBULITIS; BANFF CLASSIFICATION;

D O I：

10.1007/BF02254194

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

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 greater than or equal to 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.

引用

页码：309 / 312

页数：4

共 21 条

[1]

Sibley R.K., Payne W., Morphologic findings in the renal allograft biopsy, Semin Nephrol, 5, pp. 294-305, (1985)

[2]

Olsen T.S., Pathology of allograft rejection, Kidney transplant rejection: diagnosis and treatment, pp. 333-357, (1992)

[3]

Medawar P.B., The behaviour and fate of skin autografts and skin homografts in rabbits, J Anat, 78, pp. 176-199, (1944)

[4]

Mitchison N.A., Dube O.L., Studies on immunological response to foreign tumor transplants in the mouse. II. Relation between hemagglutinating antibody and graft resistance in normal mouse and mice pretreated with tissue preperations, Journal of Experimental Medicine, 102, pp. 179-199, (1955)

[5]

Solez K., Marcussen N., Flynn G.J., Beshorner W.E., Racusen L.C., Burdick J.F., Pathology of acute tubular necrosis and acute rejection, kidney transplant rejection: diagnosis and treatment, pp. 373-392, (1992)

[6]

Matas A.J., Sibley R., Mauer M., Sutherland D.E., Simmons R.L., Najarian J.S., The value of needle renal allograft biopsy. I. A retrospective study of biopsies performed during putative rejection episodes, Ann Surg, 197, pp. 226-237, (1983)

[7]

Gray D.W.R., Richardson A., Hughes D., Fuggles S., Dunnill M., Higgins R., McWhinnie D., Morris P.J., A prospective, randomized, blind comparison of three biopsy techniques in the management of patients after renal transplantation, Transplantation, 53, pp. 1226-1232, (1992)

[8]

Burdick J.F., Bechorner W.E., Smith W.J., McGraw D.J., Bender W.L., Willia G.M., Solez K., Characteristics of early routine renal allograft biopsies, Transplantation, 38, pp. 679-684, (1984)

[9]

Versluis D.J., ten Kate F.J., Wenting G.J., Weimar W., Mononuclear cells infiltrating allografts in the absence of rejection: effect of conversion from cyclosporin to azathioprine therapy, Transplant Int, 1, pp. 205-208, (1988)

[10]

Guettier C., Nochy S., Hinglais N., Pelletier L., Mandet C., Bedrossian J., Duboust A., Moulonguet, Camilleri J.P., Bariety J., Distinct phenotypic composition of diffuse interstitial and perivascular focal infiltrates in renal allografts: a morphometric analysis of cellular infiltration under conventional immunosuppressive therapy and under cyclosporine A, Clin Neprol, 30, pp. 97-105, (1988)

← 1 2 3 →