留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

同种异体复合组织移植Banff移植病理学诊断标准及进展

熊艳, 叶啟发, 孔凡华, 等. 同种异体复合组织移植Banff移植病理学诊断标准及进展[J]. 器官移植, 2022, 13(4): 425-433. doi: 10.3969/j.issn.1674-7445.2022.04.003
引用本文: 熊艳, 叶啟发, 孔凡华, 等. 同种异体复合组织移植Banff移植病理学诊断标准及进展[J]. 器官移植, 2022, 13(4): 425-433. doi: 10.3969/j.issn.1674-7445.2022.04.003
Xiong Yan, Ye Qifa, Kong Fanhua, et al. Diagnostic criteria and research progress on Banff classification of allograft pathology in composite tissue allotransplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(4): 425-433. doi: 10.3969/j.issn.1674-7445.2022.04.003
Citation: Xiong Yan, Ye Qifa, Kong Fanhua, et al. Diagnostic criteria and research progress on Banff classification of allograft pathology in composite tissue allotransplantation[J]. ORGAN TRANSPLANTATION, 2022, 13(4): 425-433. doi: 10.3969/j.issn.1674-7445.2022.04.003

同种异体复合组织移植Banff移植病理学诊断标准及进展

doi: 10.3969/j.issn.1674-7445.2022.04.003
基金项目: 

国家人体捐献器官获取质量管理与控制中心科研业务专项资金资助 PTPP2021007

中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助 2019PT320014

详细信息
    作者简介:
    通讯作者:

    叶啟发,男,1954年生,医学博士,教授,主任医师,研究方向为肝移植临床和基础研究、天然高分子生物肝临床转化研究,Email:yqf_china@163.com

    郭晖,研究方向为移植病理学基础与临床应用研究,Email:zcguo@tjh.tjmu.edu.cn

  • 中图分类号: R617, S857.13+3

Diagnostic criteria and research progress on Banff classification of allograft pathology in composite tissue allotransplantation

More Information
  • 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。

     

  • 图  1  移植皮肤急性排斥反应的血管周围炎和皮肤附属器炎症的病理学表现

    注:A图示皮肤的真皮组织内炎症细胞围绕小血管呈“围管状浸润”(箭头所示)(苏木素-伊红,×400);B图示皮肤的真皮组织内炎症细胞浸润汗腺呈皮肤附属器的炎症(箭头所示)(苏木素-伊红,×200)。

    Figure  1.  Pathological findings of perivascular inflammation and skin adnexal inflammation in acute rejection of skin graft

    图  2  移植皮肤急性排斥反应的表皮损伤的病理学表现

    注:A图示真皮组织内浸润的淋巴细胞向表皮基底部及表皮角浸润扩展致表皮基底细胞凋亡(箭头所示)(苏木素-伊红,×200);B图示表皮层内中间部分,部分鳞状上皮细胞水肿致细胞间间隙加大呈海绵样改变(箭头所示),以及散在个别鳞状上皮细胞显著水肿肿胀呈囊泡(“V”所示)(苏木素-伊红,×200);C图示严重的急性排斥反应致表皮坏死脱落(箭头所示)(苏木素-伊红,×400)。

    Figure  2.  Pathological findings of epidermal damage in acute rejection of skin graft

    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
    下载: 导出CSV
  • [1] ISKE J, NIAN Y, MAENOSONO R, et al. Composite tissue allotransplantation: opportunities and challenges[J]. Cell Mol Immunol, 2019, 16(4): 343-349. DOI: 10.1038/s41423-019-0215-3.
    [2] OZKAN O, ERTOSUN MG, OZKAN O. Technical, immunological, and ethical similarities and differences between vascularized composite allotransplantation and solid organ transplantation in current practice[J]. Transplant Proc, 2018, 50(10): 3775-3782. DOI: 10.1016/j.transproceed.2018.06.012.
    [3] LELLOUCH AG, TAVEAU CB, ANDREWS AR, et al. Local FK506 implants in non-human primates to prevent early acute rejection in vascularized composite allografts[J]. Ann Transl Med, 2021, 9(13): 1070. DOI: 10.21037/atm-21-313.
    [4] HERNANDEZ JA, MILLER J, OLECK NC, et al. OPTN/SRTR 2020 annual data report: VCA[J]. Am J Transplant, 2022, 22 (Suppl 2): 623-647. DOI: 10.1111/ajt.16980.
    [5] GEOGHEGAN L, AL-KHALIL M, SCARBOROUGH A, et al. Pre-transplant management and sensitisation in vascularised composite allotransplantation: a systematic review[J]. J Plast Reconstr Aesthet Surg, 2020, 73(9): 1593-1603. DOI: 10.1016/j.bjps.2020.05.010.
    [6] CENDALES LC, KANITAKIS J, SCHNEEBERGER S, et al. The Banff 2007 working classification of skin-containing composite tissue allograft pathology[J]. Am J Transplant, 2008, 8(7): 1396-1400. DOI: 10.1111/j.1600-6143.2008.02243.x.
    [7] MENDENHALL SD, BROWN S, BEN-AMOTZ O, et al. Building a hand and upper extremity transplantation program: lessons learned from the first 20 years of vascularized composite allotransplantation[J]. Hand (N Y), 2020, 15(2): 224-233. DOI: 10.1177/1558944718790579.
    [8] KAUFMAN CL, KANITAKIS J, WEISSENBACHER A, et al. Defining chronic rejection in vascularized composite allotransplantation-the American Society of Reconstructive Transplantation and International Society of Vascularized Composite Allotransplantation chronic rejection working group: 2018 American Society of Reconstructive Transplantation meeting report and white paper research goals in defining chronic rejection in vascularized composite allotransplantation[J]. SAGE Open Med, 2020, 8: 2050312120940421. DOI: 10.1177/2050312120940421.
    [9] MATAR AJ, CREPEAU RL, MUNDINGER GS, et al. Large animal models of vascularized composite allotransplantation: a review of immune strategies to improve allograft outcomes[J]. Front Immunol, 2021, 12: 664577. DOI: 10.3389/fimmu.2021.664577.
    [10] CONRAD A, PETRUZZO P, KANITAKIS J, et al. Infections after upper extremity allotransplantation: a worldwide population cohort study, 1998-2017[J]. Transpl In, 2019, 32(7): 693-701. DOI: 10.1111/tri.13399.
    [11] KANITAKIS J. The challenge of dermatopathological diagnosis of composite tissue allograft rejection: a review[J]. J Cutan Pathol, 2008, 35(8): 738-744. DOI: 10.1111/j.1600-0560.2007.00889.x.
    [12] SIKORSKA D, KAMIŃSKA D, CATAR R, et al. Non-HLA antibodies in hand transplant recipients are connected to multiple acute rejection episodes and endothelial activation[J]. J Clin Med, 2022, 11(3): 833. DOI: 10.3390/jcm11030833.
    [13] ANGGELIA MR, CHENG HY, CHUANG WY, et al. Unraveling the crucial roles of FoxP3+ regulatory T cells in vascularized composite allograft tolerance induction and maintenance[J]. Transplantation, 2021, 105(6): 1238-1249. DOI: 10.1097/TP.0000000000003509.
    [14] MESSNER F, FISCHER AC, RUNGGALDIER E, et al. Mechanical irritation in vascularized composite tissue allotransplantation triggers localized skin rejection[J]. Transplantation, 2020, 104(5): 956-969. DOI: 10.1097/TP.0000000000003075.
    [15] CHANDRAKER A, ARSCOTT R, MURPHY GF, et al. The management of antibody-mediated rejection in the first presensitized recipient of a full-face allotransplant[J]. Am J Transplant, 2014, 14(6): 1446-1452. DOI: 10.1111/ajt.12715.
    [16] UNADKAT JV, SCHNEEBERGER S, GOLDBACH C, et al. Investigation of antibody-mediated rejection in composite tissue allotransplantation in a rat limb transplant model[J]. Transplant Proc, 2009, 41(2): 542-545. DOI: 10.1016/j.transproceed.2009.01.024.
    [17] KANITAKIS J, MCGREGOR B, BADET L, et al. Absence of C4d deposition in human composite tissue (hands and face) allograft biopsies: an immunoperoxidase study[J]. Transplantation, 2007, 84(2): 265-267. DOI: 10.1097/01.tp.0000266899.93315.52.
    [18] MORELON E, KANITAKIS J, PETRUZZO P. Immunological issues in clinical composite tissue allotransplantation: where do we stand today?[J]. Transplantation, 2012, 93(9): 855-859. DOI: 10.1097/TP.0b013e31824728b8.
    [19] MENGEL M, SIS B, HAAS M, et al. Banff 2011 meeting report: new concepts in antibody-mediated rejection[J]. Am J Transplant, 2012, 12(3): 563-570. DOI: 10.1111/j.1600-6143.2011.03926.x.
    [20] PETRUZZO P, KANITAKIS J, BADET L, et al. Long-term follow-up in composite tissue allotransplantation: in-depth study of five (hand and face) recipients[J]. Am J Transplant, 2011, 11(4): 808-816. DOI: 10.1111/j.1600-6143.2011.03469.x.
    [21] LODHI SA, LAMB KE, MEIER-KRIESCHE HU. Solid organ allograft survival improvement in the United States: the long-term does not mirror the dramatic short-term success[J]. Am J Transplant, 2011, 11(6): 1226-1235. DOI: 10.1111/j.1600-6143.2011.03539.x.
    [22] KOLLAR B, KAMAT P, KLEIN HJ, et al. The significance of vascular alterations in acute and chronic rejection for vascularized composite allotransplantation[J]. J Vasc Res, 2019, 56(4): 163-180. DOI: 10.1159/000500958.
    [23] DIEP GK, BERMAN ZP, ALFONSO AR, et al. The 2020 facial transplantation update: a 15-year compendium[J]. Plast Reconstr Surg Glob Open, 2021, 9(5): e3586. DOI: 10.1097/GOX.0000000000003586.
    [24] HEWITT CW, RAMSAMOOJ R, PATEL MP, et al. Development of stable mixed T cell chimerism and transplantation tolerance without immune modulation in recipients of vascularized bone marrow allografts[J]. Transplantation, 1990, 50(5): 766-772. DOI: 10.1097/00007890-199011000-00006.
    [25] BROUHA PC, PEREZ-ABADIA G, FRANCOIS CG, et al. Lymphadenectomy prior to rat hind limb allotransplantation prevents graft-versus-host disease in chimeric hosts[J]. Transpl Int, 2004, 17(7): 341-350. DOI: 10.1007/s00147-004-0724-5.
    [26] GRANGER DK, BRIEDENBACH WC, PIDWELL DJ, et al. Lack of donor hyporesponsiveness and donor chimerism after clinical transplantation of the hand[J]. Transplantation, 2002, 74(11): 1624-1630. DOI: 10.1097/00007890-200212150-00022.
    [27] SHULMAN HM, KLEINER D, LEE SJ, et al. Histopathologic diagnosis of chronic graft-versus-host disease: National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: Ⅱ. Pathology Working Group report[J]. Biol Blood Marrow Transplant, 2006, 12(1): 31-47. DOI: 10.1016/j.bbmt.2005.10.023.
    [28] STEINBRINK JM, WOLFE CR. Infectious complications of vascularized composite allograft transplantation[J]. Curr Opin Organ Transplant, 2020, 25(4): 377-382. DOI: 10.1097/MOT.0000000000000780.
    [29] KAUKE-NAVARRO M, PANAYI AC, FORMICA R, et al. Cytomegalovirus-related complications and management in facial vascularized composite allotransplantation: an international multicenter retrospective cohort study[J]. Transplantation, 2022, DOI: 10.1097/TP.0000000000004132[Epub ahead of print].
    [30] TCHILOEMBA B, KAUKE M, HAUG V, et al. Long-term outcomes after facial allotransplantation: systematic review of the literature[J]. Transplantation, 2021, 105(8): 1869-1880. DOI: 10.1097/TP.0000000000003513.
    [31] ROY SF, KRISHNAN V, TRINH VQ, et al. Lymphocytic vasculitis associated with mild rejection in a vascularized composite allograft recipient: a clinicopathological study[J]. Transplantation, 2020, 104(7): e208-e213. DOI: 10.1097/TP.0000000000003241.
    [32] FULLERTON ZH, TSANGARIS E, DEVRIES CEE, et al. Patient-reported outcomes measures used in facial vascularized composite allotransplantation: a systematic literature review[J]. J Plast Reconstr Aesthet Surg, 2022, 75(1): 33-44. DOI: 10.1016/j.bjps.2021.09.002.
    [33] LASSUS P, LINDFORD A, VUOLA J, et al. The Helsinki face transplantation: surgical aspects and 1-year outcome[J]. J Plast Reconstr Aesthet Surg, 2018, 71(2): 132-139. DOI: 10.1016/j.bjps.2017.10.007.
    [34] GOVSHIEVICH A, SALEH E, BOGHOSSIAN E, et al. Face transplant: current update and first Canadian experience[J]. Plast Reconstr Surg, 2021, 147(5): 1177-1188. DOI: 10.1097/PRS.0000000000007890.
    [35] SHOKRI T, SAADI R, WANG W, et al. Facial transplantation: complications, outcomes, and long-term management strategies[J]. Semin Plast Surg, 2020, 34(4): 245-253. DOI: 10.1055/s-0040-1721760.
  • 加载中
图(3) / 表(1)
计量
  • 文章访问数:  437
  • HTML全文浏览量:  237
  • PDF下载量:  99
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-04-24
  • 网络出版日期:  2022-07-14
  • 刊出日期:  2022-07-15

目录

    /

    返回文章
    返回