Evolving thresholds for the diagnosis of acute T cell mediated rejection.

IF 2.2 3区医学 Q3 PERIPHERAL VASCULAR DISEASE

Current Opinion in Nephrology and Hypertension Pub Date : 2025-05-01 Epub Date: 2025-03-19 DOI:10.1097/MNH.0000000000001072

Brian J Nankivell

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引用次数: 0

Abstract

Purpose of review: The Banff schema uses combinations of pathological lesions at predefined thresholds to diagnose of T cell rejection (TCMR) and grade its severity. Constant definitional changes have caused confusion among clinicians and pathologists. This review describes the evolution of lesion definitions and the rationale for the minimal thresholds.

Recent findings: The minimal diagnostic threshold for borderline TCMR has been reset to original Banff i1/t1, where isolated tubulitis is now excluded. Arteritis can be mediated by either Grade II TCMR or caused by donor specific antibody as antibody-mediated vascular rejection. The conservative threshold for chronic active TCMR diagnosis uses moderate total and scarred inflammation with tubulitis has been challenged by recent longitudinal data to suggest lower thresholds including i-IFTA=1 as clinically relevant.

Summary: Minor changes in the threshold ruleset can cause substantial alterations in the final pathological diagnoses. While minimal thresholds for borderline and active TCMR have now stabilized, future changes are likely for chronic active TCMR pending confirmatory research.

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进化阈值诊断急性T细胞介导的排斥反应。

回顾目的：Banff模式使用预定义阈值的病理病变组合来诊断T细胞排斥反应（TCMR）并对其严重程度进行分级。不断的定义变化引起了临床医生和病理学家之间的混淆。这篇综述描述了病变定义的演变和最小阈值的基本原理。最近发现：边缘性TCMR的最低诊断阈值已重置为最初的Banff i /t1，其中孤立性小管炎现在被排除在外。动脉炎既可以由二级TCMR介导，也可以由供体特异性抗体引起，如抗体介导的血管排斥反应。慢性活动性TCMR诊断的保守阈值使用中度总炎症和结痂性炎症伴小管炎，最近的纵向数据提出了挑战，表明包括i-IFTA=1在内的较低阈值具有临床相关性。总结：阈值规则集的微小变化可能导致最终病理诊断的实质性改变。虽然边缘性和活动性TCMR的最低阈值现在已经稳定，但慢性活动性TCMR的未来可能会发生变化，有待证实性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Nephrology and Hypertension 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

6.20%

发文量

132

审稿时长

6-12 weeks

期刊介绍： A reader-friendly resource, Current Opinion in Nephrology and Hypertension provides an up-to-date account of the most important advances in the field of nephrology and hypertension. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including pathophysiology of hypertension, circulation and hemodynamics, and clinical nephrology. Current Opinion in Nephrology and Hypertension is an indispensable journal for the busy clinician, researcher or student.