Significance of revised criteria for chronic active T cell-mediated rejection in the 2017 Banff classification: Surveillance by 1-year protocol biopsies for kidney transplantation
Significance of revised criteria for chronic active T cell-mediated rejection in the 2017 Banff classification: Surveillance by 1-year protocol biopsies for kidney transplantation
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DOI：
10.1111/ajt.16093
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发表时间：
2021-01-01
影响因子：
8.8
通讯作者：
Kitazono, Takanari
中科院分区：
文献类型：
--
作者：
Nakagawa, Kaneyasu;Tsuchimoto, Akihiro;Kitazono, Takanari
慢性活动性T细胞介导的排斥反应（CA-TCMR）的诊断标准在Banff 2017共识中进行了修订，但尚不清楚新标准是否能预测肾移植的移植物预后。我们入组了406例接受1年方案活检（PB）的肾移植受者，并研究了Banff 2017的诊断意义。3位诊断医生的观察者间重复性显示Fleiss kappa系数的基本一致率为0.68。根据Banff 2017，33例患者（8%）被归类为CA-TCMR，根据Banff 2015标准，6例既往诊断为正常，12例为急性TCMR，10例为临界变化，5例为CA-TCMR。CA-TCMR的决定性因素是环孢霉素的使用（与他克莫司相比）、既往急性排斥反应和BK多瘤病毒相关肾病。在生存分析中，CA-TCMR的新诊断预测了复合移植终点，定义为血清肌酐加倍或死亡删失的移植物丢失（对数秩检验，P < .001）。在多变量分析中，CA-TCMR与复合终点的第二高风险相关（风险比：5.42; 95%置信区间，2.02-14.61; P < .001 vs正常），仅次于抗体介导的排斥反应。总之，Banff 2017中CA-TCMR的诊断可能有助于检测接受1年PB的肾移植受者的不良预后。
Diagnostic criteria for chronic active T cell-mediated rejection (CA-TCMR) were revised in the Banff 2017 consensus, but it is unknown whether the new criteria predict graft prognosis of kidney transplantation. We enrolled 406 kidney allograft recipients who underwent a 1-year protocol biopsy (PB) and investigated the diagnostic significance of Banff 2017. Interobserver reproducibility of the 3 diagnosticians showed a substantial agreement rate of 0.68 in Fleiss's kappa coefficient. Thirty-three patients (8%) were classified as CA-TCMR according to Banff 2017, and 6 were previously diagnosed as normal, 12 as acute TCMR, 10 with borderline changes, and 5 as CA-TCMR according to Banff 2015 criteria. Determinant factors of CA-TCMR were cyclosporine use (vs tacrolimus), previous acute rejection, and BK polyomavirus-associated nephropathy. In survival analysis, the new diagnosis of CA-TCMR predicted a composite graft endpoint defined as doubling serum creatinine or death-censored graft loss (log-rank test, P < .001). In multivariate analysis, CA-TCMR was associated with the second highest risk of the composite endpoint (hazard ratio: 5.42; 95% confidence interval, 2.02-14.61; P < .001 vs normal) behind antibody-mediated rejection. In conclusion, diagnosis of CA-TCMR in Banff 2017 may facilitate detecting an unfavorable prognosis of kidney allograft recipients who undergo a 1-year PB.