دورية أكاديمية
أعرض في EDS

The Histological Spectrum and Clinical Significance of T Cell-mediated Rejection of Kidney Allografts.

التفاصيل البيبلوغرافية
العنوان: The Histological Spectrum and Clinical Significance of T Cell-mediated Rejection of Kidney Allografts.
المؤلفون: Filippone EJ; Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA., Farber JL; Department of Pathology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
المصدر: Transplantation [Transplantation] 2023 May 01; Vol. 107 (5), pp. 1042-1055. Date of Electronic Publication: 2022 Dec 19.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0132144 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-6080 (Electronic) Linking ISSN: 00411337 NLM ISO Abbreviation: Transplantation Subsets: MEDLINE
أسماء مطبوعة: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore, Williams & Wilkins.
مواضيع طبية MeSH: T-Lymphocytes* , Kidney Transplantation*/adverse effects, Humans ; Clinical Relevance ; Risk Factors ; Kidney/pathology ; Isoantibodies ; Inflammation/etiology ; Allografts/pathology ; Graft Rejection ; Biopsy
مستخلص: T cell-mediated rejection (TCMR) remains a significant cause of long-term kidney allograft loss, either indirectly through induction of donor-specific anti-HLA alloantibodies or directly through chronic active TCMR. Whether found by indication or protocol biopsy, Banff defined acute TCMR should be treated with antirejection therapy and maximized maintenance immunosuppression. Neither isolated interstitial inflammation in the absence of tubulitis nor isolated tubulitis in the absence of interstitial inflammation results in adverse outcomes, and neither requires antirejection treatment. RNA gene expression analysis of biopsy material may supplement conventional histology, especially in ambiguous cases. Lesser degrees of tubular and interstitial inflammation (Banff borderline) may portend adverse outcomes and should be treated when found on an indication biopsy. Borderline lesions on protocol biopsies may resolve spontaneously but require close follow-up if untreated. Following antirejection therapy of acute TCMR, surveillance protocol biopsies should be considered. Minimally invasive blood-borne assays (donor-derived cell-free DNA and gene expression profiling) are being increasingly studied as a means of following stable patients in lieu of biopsy. The clinical benefit and cost-effectiveness require confirmation in randomized controlled trials. Treatment of acute TCMR is not standardized but involves bolus corticosteroids with lymphocyte depleting antibodies for severe, refractory, or relapsing cases. Arteritis may be found with acute TCMR, active antibody-mediated rejection, or mixed rejections and should be treated accordingly. The optimal treatment ofchronic active TCMR is uncertain. Randomized controlled trials are necessary to optimally define therapy.
(Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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المشرفين على المادة: 0 (Isoantibodies)
تواريخ الأحداث: Date Created: 20221230 Date Completed: 20230427 Latest Revision: 20230523
رمز التحديث: 20240628
DOI: 10.1097/TP.0000000000004438
PMID: 36584369
قاعدة البيانات: MEDLINE
الوصف
تدمد:1534-6080
DOI:10.1097/TP.0000000000004438