Diagnostic criteria and research progress on Banff classification of allograft pathology in composite tissue allotransplantation
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摘要: 同种异体复合组织移植(CTA)是一门新兴的用于治疗功能性组织或肢体缺损的移植学科,由于绝大多数CTA移植物为带血管的移植物,因此也称为带血管的复合组织移植(VCA)。CTA/VCA的移植物包含同种异体的皮肤、皮下组织、骨骼、肌肉、神经和血管等两种或多种组织结构成分。由于大多数CTA/VCA移植物中带有皮肤组织,而皮肤组织是抗原性最强的免疫成分,移植术后的急性排斥反应是导致CTA/VCA移植失败及其移植物失功的首要障碍, 因此CTA/VCA移植物中的皮肤排斥反应的组织病理学特征成为首要的关注点。本文就CTA/VCA的排斥反应等病理学特征、2007年Banff诊断标准及其研究进展予以综述,以期为CTA/VCA的排斥反应及其他并发症的诊断及治疗提供参考。
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关键词:
- 同种异体复合组织移植(CTA) /
- 带血管的复合组织移植(VCA) /
- 活组织检查 /
- 抗体介导的排斥反应(AMR) /
- T细胞介导的排斥反应(TCMR) /
- C4d染色 /
- 移植物抗宿主反应(GVHR) /
- 供者特异性抗体(DSA)
Abstract: Composite tissue allotransplantation (CTA) is a novel transplantation discipline to treat functional tissue or limb defects. Since a majority of CTA grafts were vascularized grafts, it is also known as vascularized composite allotransplantation (VCA). The grafts of CTA/VCA consist of two or more types of allogeneic skin, subcutaneous tissue, bone, muscle, nerve and vessel, etc. Most of CTA/VCA grafts contain skin tissues, which possess the highest antigenicity. Acute rejection after transplantation is the primary obstacle leading to CTA/VCA graft failure and primary graft dysfunction. Hence, histopathological characteristics of skin rejection in CTA/VCA grafts have become the primary hotspot. In this article, pathological features of CTA/VCA rejection, Banff classification in 2007 and related research progress were reviewed, aiming to provide reference for the diagnosis and treatment of rejection and other complications of CTA/VCA. -
表 1 移植皮肤急性排斥反应的Banff分级
Table 1. Banff schema for grading acute rejection of skin graft
分级 诊断标准 0级(正常) 无或罕见炎症细胞浸润 Ⅰ级(轻度) 血管周围轻度炎症细胞浸润,不累及表皮 Ⅱ级(中度) 中-重度血管周围炎症细胞浸润,伴或不伴轻度表皮和(或)皮肤附属器的受累(限于海绵状突起和胞吐),无表皮角化不良或细胞凋亡 Ⅲ级(重度) 密集的炎症和表皮细胞凋亡,角化不良和(或)角化溶解 Ⅳ级(严重) 坏死性急性排斥反应,表皮或其他皮肤结构明显坏死 -
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