Peritubular capillaritis in renal allografts: Prevalence, scoring system, reproducibility and clinicopathological correlates
Peritubular capillaritis in renal allografts: Prevalence, scoring system, reproducibility and clinicopathological correlates
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DOI：
10.1111/j.1600-6143.2007.02137.x
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发表时间：
2008-04-01
影响因子：
8.8
通讯作者：
Mengel, M.
中科院分区：
文献类型：
--
作者：
Gibson, I. W.;Gwinner, W.;Mengel, M.
虽然肾小球炎症是根据Banff分类进行分级的，但尚未建立肾小管周围毛细血管炎(PTC)的评分标准。我们对688例移植肾(植入前46例，方案461例，适应症181例)采用PTC评分标准，共26.3%的分析活检有管周毛细管炎(植入0%，方案17.6%，适应症45.5%；p<；0.0001)。最常见的毛细管炎类型是中等程度(5-10个管腔细胞)，范围局限(占PTC的10-50%)，少数中性粒细胞。总共有24%的C4D-与75%的C4D+活检显示毛细管炎(p<；0.0001)。超过80%的肾小球炎活组织检查有管周毛细管炎。50.4%的有交界性或T细胞介导的排斥反应(TCMR)的活检组织和14.1%的无TCMR或抗体介导的排斥反应(ABMR)的活检组织显示毛细管炎(P<；0.0001)。PTC评分特征的观察者间重复性为中等至中等。根据移植后2年肾小球滤过率，早期方案活检中发现的弥漫性毛细血管炎对预后有显著的负面影响。适应症活检显示毛细管炎的患病率明显高于常规活检(45.5%vs.17.6%；p<；0.0001)。毛细血管炎在ABMR中更为常见和明显，但可以在TCMR病例中观察到。因此，肾小管周围毛细血管炎的评分是可行的，可以为移植肾活检提供预后和诊断信息。
While glomerulitis is graded according to the Banff classification, no criteria for scoring peritubular capillaritis (PTC) have been established. We retrospectively applied PTC-scoring criteria to 688 renal allograft (46 preimplantation, 461 protocol, 181 indication) biopsies.A total of 26.3% of all analyzed biopsies had peritubular capillaritis (implant 0%, protocol 17.6%, indication 45.5%; p < 0.0001). The most common capillaritis pattern was of moderate severity (5-10 luminal cells), focal in extent (10-50% of PTC), with a minority of neutrophils. A total of 24% of C4d- compared with 75% of C4d+ biopsies showed capillaritis (p < 0.0001). More than 80% of biopsies with glomerulitis had peritubular capillaritis. A total of 50.4% of biopsies with borderline or T-cell mediated rejection (TCMR) and 14.1% of biopsies without TCMR or antibody-mediated rejection (ABMR) showed capillaritis (p < 0.0001). The inter-observer reproducibility of the PTC-scoring features was fair to moderate. Diffuse capillaritis detected in early protocol biopsies had significant negative prognostic impact in terms of glomerular filtration rate 2 years posttransplantation. Indication biopsies show a significantly higher prevalence of capillaritis than protocol biopsies (45.5% vs. 17.6%; p < 0.0001). Capillaritis is more frequent and pronounced in ABMR, but can be observed in TCMR cases. Thus, scoring of peritubular capillaritis is feasible and can provide prognostic and diagnostic information in renal allograft biopsies.