3 years ago

Recognition of i-IF/TA as a component of the T cell-mediated rejection spectrum: Unselected population approach versus random case selection

Carmen Lefaucheur, Denis Viglietti, Alexandre Loupy
Whereas chronic active T cell-mediated rejection (TCMR) has long been acknowledged by the Banff classification, the spectrum of chronic active TCMR lesions was until now restricted to chronic allograft arteriopathy, without any consideration for chronic tubulo-interstitial injury following the acute infiltration of the interstitium and tubules by T cells and macrophages characterizing acute TCMR. To date, active TCMR has been defined only in the non-fibrotic areas of the allograft cortex and this artificial compartmentalization of the alloreactive response seems to have little biological relevance. The recognition of interstitial inflammation in fibrotic areas (i-IF/TA) and tubulitis in atrophic tubules (t-IF/TA) as components of chronic active TCMR represents a step forward in our understanding of the temporality and natural history of the TCMR process, consistent with the natural history of antibody-mediated rejection, which has been modified in the current era of more potent immunosuppression with the emergence of subclinical and chronic active forms. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14667

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