Guidelines for the Diagnosis of Antibody-Mediated Rejection in Pancreas Allografts-Updated Banff Grading Schema

被引：90

作者：

Drachenberg, C. B. ^{[1
]}

Torrealba, J. R. ^{[2
]}

Nankivell, B. J. ^{[3
]}

Rangel, E. B. ^{[4
]}

Bajema, I. M. ^{[5
]}

Kim, D. U. ^{[6
]}

Arend, L. ^{[7
]}

Bracamonte, E. R. ^{[8
]}

Bromberg, J. S. ^{[9
]}

Bruijn, J. A. ^{[5
]}

Cantarovich, D. ^{[10
]}

Chapman, J. R. ^{[3
]}

Farris, A. B. ^{[12
]}

Gaber, L. ^{[13
]}

Goldberg, J. C. ^{[14
]}

Haririan, A. ^{[15
]}

Honsova, E. ^{[16
]}

Iskandar, S. S. ^{[17
]}

Klassen, D. K. ^{[15
]}

Kraus, E.

Lower, F. ^{[18
]}

Odorico, J. ^{[19
]}

Olson, J. L. ^{[20
]}

Mittalhenkle, A. ^{[21
]}

Munivenkatappa, R. ^{[9
]}

Paraskevas, S. ^{[23
]}

Papadimitriou, J. C. ^{[1
]}

Randhawa, P. ^{[24
]}

Reinholt, F. P. ^{[26
,27
]}

Renaudin, K. ^{[11
]}

Revelo, P. ^{[28
]}

Ruiz, P. ^{[29
,30
]}

Samaniego, M. D. ^{[31
]}

Shapiro, R. ^{[23
,25
]}

Stratta, R. J.

Sutherland, D. E. R. ^{[32
]}

Troxell, M. L. ^{[20
,22
]}

Voska, L. ^{[16
]}

Seshan, S. V. ^{[33
]}

Racusen, L. C. ^{[7
]}

Bartlett, S. T. ^{[9
]}

机构：

[1] Univ Maryland, Sch Med, Dept Pathol, Baltimore, MD 21201 USA

[2] Univ Wisconsin, Sch Med, Dept Pathol & Lab Med, Madison, WI USA

[3] Univ Sidney, Westmead Hosp, Dept Renal Med, Sydney, NSW, Australia

[4] HIAE, Hosp Israelita Albert Einstein, Pancreas Kidney Transplantat Unit, Sao Paulo, Brazil

[5] Leiden Univ, Dept Pathol, Med Ctr, Leiden, Netherlands

[6] St Barnabas Hosp, Dept Pathol, Livingston, NJ USA

[7] Johns Hopkins Univ, Dept Pathol, Baltimore, MD USA

[8] Univ Arizona, Dept Pathol, Tucson, AZ USA

[9] Univ Maryland, Sch Med, Dept Surg, Baltimore, MD 21201 USA

[10] CHU Hotel Dieu, Dept Nephrol, Nantes, France

[11] CHU Hotel Dieu, Dept Pathol, Nantes, France

[12] Emory Univ, Sch Med, Dept Pathol, Atlanta, GA 30322 USA

[13] Weill Cornell Med Coll, Methodist Hosp, Dept Pathol, Houston, TX USA

[14] Inst Nefrol, Buenos Aires, DF, Argentina

[15] Univ Maryland, Sch Med, Dept Med, Baltimore, MD 21201 USA

[16] Inst Clin & Expt Med, Dept Pathol, Prague, Czech Republic

[17] Wake Forest Univ, Bowman Gray Sch Med, Dept Pathol, Winston Salem, NC 27103 USA

[18] So Illinois Univ, Sch Med, Springfield, IL USA

[19] Univ Wisconsin, Dept Surg, Sch Med & Publ Hlth, Madison, WI USA

[20] Univ Calif San Francisco, Dept Pathol, San Francisco, CA 94140 USA

[21] Oregon Hlth & Sci Univ, Dept Med, Div Nephrol & Hypertens, Portland, OR 97201 USA

[22] Oregon Hlth & Sci Univ, Dept Pathol, Div Nephrol & Hypertens, Portland, OR 97201 USA

[23] McGill Univ, Dept Surg, Montreal, PQ H3A 2T5, Canada

[24] Univ Pittsburgh, Dept Pathol, Div Transplantat Pathol, Pittsburgh, PA USA

[25] Univ Pittsburgh, Dept Surg, Div Transplantat Pathol, Pittsburgh, PA USA

[26] Univ Oslo, Dept Pathol, Oslo, Norway

[27] Univ Oslo, Rikshosp, Oslo Univ Hosp, N-0027 Oslo, Norway

[28] Univ Utah, Dept Pathol & Lab Med, Salt Lake City, UT USA

[29] Univ Miami, Dept Pathol, Miami, FL USA

[30] Univ Miami, Dept Surg, Miami, FL USA

[31] Univ Michigan, Dept Internal Med, Ann Arbor, MI 48109 USA

[32] Univ Minnesota, Dept Surg, Div Transplantat & Diabet, Inst Immunol & Transplantat, Minneapolis, MN 55455 USA

[33] Weill Cornell Med Coll, Dept Pathol, New York, NY USA

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2011年 / 11卷 / 09期

关键词：

Acinar cell injury; active chronic antibody-mediated rejection; amylin; amyloid; C4d; cell-mediated rejection; donor-specific antibody; interacinar capillaries; pancreas biopsy; transplant arteriopathy; DONOR-SPECIFIC ANTIBODY; NORMAL HUMAN ORGANS; HLA CLASS-II; KIDNEY-TRANSPLANTATION; RENAL-ALLOGRAFTS; DETAILED DISTRIBUTION; CLINICAL CORRELATIONS; DIABETES-MELLITUS; HUMORAL REJECTION; GENE-EXPRESSION;

D O I：

10.1111/j.1600-6143.2011.03670.x

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

The first Banff proposal for the diagnosis of pancreas rejection (Am J Transplant 2008; 8: 237) dealt primarily with the diagnosis of acute T-cell-mediated rejection (ACMR), while only tentatively addressing issues pertaining to antibody-mediated rejection (AMR). This document presents comprehensive guidelines for the diagnosis of AMR, first proposed at the 10th Banff Conference on Allograft Pathology and refined by a broad-based multidisciplinary panel. Pancreatic AMR is best identified by a combination of serological and immunohistopathological findings consisting of (i) identification of circulating donor-specific antibodies, and histopathological data including (ii) morphological evidence of microvascular tissue injury and (iii) C4d staining in interacinar capillaries. Acute AMR is diagnosed conclusively if these three elements are present, whereas a diagnosis of suspicious for AMR is rendered if only two elements are identified. The identification of only one diagnostic element is not sufficient for the diagnosis of AMR but should prompt heightened clinical vigilance. AMR and ACMR may coexist, and should be recognized and graded independently. This proposal is based on our current knowledge of the pathogenesis of pancreas rejection and currently available tools for diagnosis. A systematized clinicopathological approach to AMR is essential for the development and assessment of much needed therapeutic interventions.

引用

页码：1792 / 1802

页数：11

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