journal reading 2006-10-13 present by dr. 陳志榮. the banff 97 working classification of renal...

Journal Reading2006-10-13

Present by Dr.陳志榮

The Banff 97 Working Classification of Renal Allograft Pathology

Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo T, Croker BP, Demetris AJ, Drachenberg CB, Fogo AB, Furness P, Gaber LW, Gibson IW, Glotz D, Goldberg JC, Grande J, Halloran PF, Hansen HE, Hartley B, Hayry PJ, Hill CM, Hoffman EO, Hunsicker LG, Lindblad AS, Yamaguchi Y, et al.

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. [email protected] ~ kidney International,55(2),1999, 713-23

Introduction

Standard interpretation to guide therapy and clinical trials.

Banff schema and Collaborative Clinical Trials in Transplantation (CCTT)

Method and Materials

Analysis of data using Banff classification.

Publication of and experience of the CCTT modification.

International conferences. Data from recent studies of impact

of vasculitis on transplant outcome.

Result

Specimen adequacy. Semiquantitative method. Actue/active lesion scoring. Tubulitis, intimal arteritis, interstitial infla

mmation, glomerulitis. Chronic/sclerosing lesion scoring. Interstitial fibrosis, tubular atrophy, allog

raft glomerulopathy, mesangial matrix increase.

Actue/active lesion scoring

Actue/active lesion scoring Intimal artertitis:

Lymphocytic infiltration beneath the endothelium.

Arteritis: Inflammation in the media and/or

with fibrinoid necrosis of vessel wall.

Actue/active lesion scoring

Chronic/sclerosing lesion scoring

Chronic/sclerosing lesion scoring Arteriolar hyaline change (nodular) :

Cyclosporine or FK506 toxicity. Separate from chronic vascular change.

Arteriolar hyalinosis (ah) score

Discussion

Historical review Finkelstein et al.,1976 (pre-cyclosp

orine era). Banfi et al. Matas et al., 1983 Banff classification,1991 (Banff 93)

Discussion Vasculitis in renal allograft:

Poorer response to therapy and/or outcome.

Intimal arteritis ± fibrinoid necrosis. Roche mycophenolate mofetil stud

y: 87 biopsies=> allograft loss rate. Nickeleit et al: less responsive to st

eroid.

Discussion Interstitial inflammation

I2t2 for diagnosis of rejection is likely appropriate.

Rush et al.: 1/3 asmptomatic patient (subclinical rejection) had i2t2 lesions with a less than 10% change in serum creatinine but had good treatable response.

borderline rejection i1t1 i1t2=>? Significance for rejection.

Correlate with clinical finding. With decreased function=>therapay. With stable function=> no therapy.

Discussion

Antibody-mediated component Widespread endothelial injury. Fibrinoid changes of vessel wall. Glomerular and small vessel throm

boses. Infarctions. Glomerulitis. Polymorphonuclear leukocytes in p

eritubular capillaries.

Discussion Other disease processes

Polymorphonuclear leukocyte (PMNL) in interstitium and tubular lumina.

Aucte bacterial infection. PMNL in peritubular and glomerula

r capillaries. Severe acute endothelial injury and

possible antibody-mediated rejection.

Eosinphils. Hypersensitivity reaction.

Discussion

Viral infection Megalic cells, nuclear smudging, in

tranuclear or cytoplasmic inclusions.

Cytomegalovirus, polyoma virus, adenovirus etc.

Colvin: relatively severe tubular cell injury and mild inflammation raises the possibility.

Discussion

Post-transplant lymphoproliferative disorder (PTLD) Immunoblasts, plasma cell, large cl

eaved/noncleaved cells and small round lymphocyte.

Nuclear atypia, EBV association, B cell preponderant.

D/D: rejection.

Discussion

Cyclosporine Tubular vacuolization. Microvascular toxicity: glomerular

and arterioles.

Discussion

Diagnosis==>prediction of allograft function and outcome.

Early intervention. Molecular study.

How to handle the renal transplant biopsy

D’Agati, Jennette,Silva edn.Non-neoplastic kidney diseases, Atlas of non-tumor pathology, first series, fascicle 4, 2005,p668

Materials: Two cores of tissue.

focal in early stages Glomeruli: 10≧ Arteries 2≧

Processing: Majority of specimen.

Light microscopic examination. (as renal biopsy routine)

Small portion. immunofluorescence study.

EM examination. not general reserved.

Light microscopic examination Three H&E slides. Three PAS or silver stained slides.

Glomerulitis or tubulitis, arteriolar hyaline, double contours of glomerular capillaries.

One Masson trichrome stained slide.

Interstitial fibrosis. Each section:3-4 microns.

Immunofluorescence study: C4d: routine use to exclude acute

humoral rejection. ? Full panel in early transplant peri

oid. IgM, IgG, IgA, C3,C1q,fibrinogen, k

appa and lambda light chain.

Rapid processing: Same day. Formalin-fixed. Frozen section is less reliable.

Allograft renal transplant routine protocol in WanFang Hospital.

Thank you for your attention!

journal reading 2006-10-13 present by dr. 陳志榮. the banff 97 working classification of renal...

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