Nephrology Dialysis Transplantation, Vol 14, Issue 7 1692-1697, Copyright © 1999 by Oxford University Press
F Macdonald, S Ashraf, M Picton, P Dyer, N Parrott, C Short and I Roberts
Background: The Banff classification of renal
allograft rejection grades acute tubulointerstitial rejection (AIR) by
severity of tubulitis and acute vascular rejection (AVR) by severity of
arteritis. The intensity of tubulitis has not, however, been demonstrated
to be of prognostic value and other features such as glomerulitis and
eosinophil infiltration are of uncertain significance. This study was
performed in order to determine the clinical value of this pathological
classification. Methods: Banff criteria were
correlated with outcome in 134 consecutive graft recipients transplanted in
our unit over a 3-year period (1994-1996) who experienced at least one
biopsy-confirmed acute rejection episode. Of 197 biopsies performed for the
diagnosis of rejection, 177 contained at least one artery and were suitable
for Banff grading. Tissue eosinophil counts were available for 101
biopsies. Clinical severity of rejection was classified as mild (fully
responsive to pulse steroid therapy), moderate (partially steroid
responsive) and severe (steroid unresponsive/requiring ATG therapy).
Results: Graft failure ensued in 18 of 58 patients
with AVR compared with 10 of 65 patients with AIR (P-<0.05).
Clinical severity of rejection correlated with the presence of arteritis,
but not severity of tubulitis; rejections graded I, IIA and IIB according
to the Banff' 93 classification were clinically severe in 3/68 (4%), 2/28
(7%) and 15/67 (22%) respectively (P=<0.05). The presence of
glomerulitis showed no correlation with clinical severity or graft loss.
Tissue eosinophilia (<10 eosinophils/mm2) was
present in 18 of 33 patients who had at least one episode of AVR (v1/2),
compared with 11 of 45 patients who suffered only AIR (P<0.02).
Conclusions: We conclude that: arteritis, but not
severe tubulitis or glomerulitis, is an adverse prognostic factor in acute
rejection and that tissue eosinophilia is associated with vascular
rejection. Our findings support the 1997 revision of the Banff
classification, replacing grades with types of acute rejection.
Key words: acute rejection; Banff classification;
eosinophilia; renal transplant
ORIGINAL ARTICLES
Banff criteria as predictors of outcome following acute renal allograft rejection
Department of Pathological Sciences, The University of Manchester and Renal Transplant Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9PT, UK; Corresponding author
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. Desvaux, S. Le Gouvello, M. Pastural, M. Abtahi, C. Suberbielle, N. Boeri, P. Remy, L. Salomon, P. Lang, and C. Baron Acute renal allograft rejections with major interstitial oedema and plasma cell-rich infiltrates: high {gamma}-interferon expression and poor clinical outcome Nephrol. Dial. Transplant., April 1, 2004; 19(4): 933 - 939. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. A. BOCK Steroid-Resistant Kidney Transplant Rejection: Diagnosis and Treatment J. Am. Soc. Nephrol., February 1, 2001; 12(90001): S48 - S52. [Abstract] [Full Text] [PDF]
|
|