Diagnostic significance of peritubular capillary basement membrane multilaminations in kidney allografts: old concepts revisited.
Diagnostic significance of peritubular capillary basement membrane multilaminations in kidney allografts: old concepts revisited.
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DOI：
10.1097/tp.0b013e31825f4df4
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发表时间：
2012-09-27
期刊：
影响因子：
6.2
通讯作者：
Nickeleit V
中科院分区：
文献类型：
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作者：
Liapis G;Singh HK;Derebail VK;Gasim AM;Kozlowski T;Nickeleit V
管周毛细血管和毛细血管基底膜多层损伤（PTCL）是抗体介导的慢性同种异体肾移植排斥的标志。然而，PTCL 的预测诊断价值尚未得到完整研究。我们分析了PTCL的诊断意义并提出了诊断策略。我们通过电子显微镜评估了 360 个诊断性天然标本和 187 个移植肾标本（术语：PTCL-C，严重；PTCL 亚组 C3，非常严重的多层；有关定义，请参阅材料和方法）。 PTCL 并不具有任何特定疾病的特征。 PTCL-C/C3 在自体肾脏中很少见（C，6%；C3，1%），主要与晚期血栓性微血管病相关（C：78%；C3：病例的 11%）。在同种异体移植物中，PTCL-C/C3 明显更为常见，尤其是在移植后超过 24 个月的标本中（C，47%；C3，31%）。 PTCL-C/C3 存在于急性（C，20%；C3，7%）和慢性 T 细胞排斥（C，67%；C3，29%）、钙调神经磷酸酶抑制剂毒性（C，36%；C3，18%）或 C4d+ 标本（C，61%；C3，50%）中，优势比在 4 到 36 之间。PTCL-C3 更常见主要发生在抗体介导的损伤的病例中。 PTCL-C/C3 的比值比最高 (81-117) 出现在复合损伤中，即混合慢性 T 细胞和并发的慢性抗体介导的排斥反应。 PTCL-C和C3的阳性预测值如下：所有排斥类型，89%和93%；所有班夫慢性排斥反应类型，分别为 69% 和 71%；和慢性推定抗体排斥反应分别为 37% 和 49%。不同班夫拒绝类别的 C 和 C3 相应的阴性预测值在 50% 到 94% 之间。 PTCL-C3 的存在对于诊断排斥引起的组织损伤是一个有用的辅助发现，但不能精确预测班夫排斥类别。相反，PTCL-C3 的缺失有助于排除班夫 II 类抗体介导的慢性排斥反应。
Injury to peritubular capillaries and capillary basement membrane multilamination (PTCL) is a hallmark of antibody-mediated chronic renal allograft rejection. However, the predictive diagnostic value of PTCL is incompletely studied. We analyzed the diagnostic significance of PTCL and propose diagnostic strategies. We evaluated 360 diagnostic native and 187 transplant kidney specimens by electron microscopy (terminology: PTCL-C, severe; PTCL subgroup C3, very severe multilamination; see Materials and Methods for definitions). PTCL was not pathognomonic for any specific disease. PTCL- C/C3 was rare in native kidneys (C, 6%; C3, 1 %), associated mainly with late thrombotic microangiopathy (C: 78%; C3: 11% of cases). In allografts, PTCL-C/C3 was significantly more common, especially in specimens more than 24 months after transplantation (C, 47%; C3, 31%). PTCL-C/C3 was found in acute (C, 20%; C3, 7%) and chronic T-cell rejection (C, 67%; C3,29%), calcineurin inhibitor toxicity (C, 36%; C3, 18%), or C4d+ specimens (C, 61%; C3, 50%) with odds ratios between 4 and 36. PTCL-C3 was more predominant in cases with antibody-mediated injury. Highest odds ratios (81–117) for PTCL-C/C3 were noted in combined injuries, that is, mixed chronic T-cell and concurrent chronic antibody–mediated rejection. Positive predictive values of PTCL-C and C3 are the following: all rejection types, 89% and 93%; all Banff chronic rejection types, 69% and 71%; and chronic presumptive antibody rejection, 37% and 49%, respectively. Corresponding negative predictive values of C and C3 for different Banff rejection categories are between 50% and 94%. The presence of PTCL-C3 is a helpful adjunct finding to diagnose rejection-induced tissue injury but cannot precisely predict the Banff rejection category. Conversely, the absence of PTCL-C3 is helpful in excluding chronic, Banff category II antibody-mediated rejection.