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Aktuelle Aspekte zur Diagnostik an Nierentransplantaten – „Banff and beyond“

Current insights on monitoring of renal transplants—Banff and beyond

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Zusammenfassung

Die Nierentransplantation ist die beste und einzige kurative Therapie des terminalen Nierenversagens. Wesentliche Anstrengungen für die Verbesserung der Langzeitorganfunktion wurden in die Entwicklung eines umfassenden und regelmäßig aktualisierten histologischen Analysesystems investiert (Banff-Klassifikation). Trotz dieses Überwachungsinstruments ist das mittlere Organüberleben auf 15 Jahre begrenzt. Molekulare Analysen haben das Verständnis schädigender pathophysiologischer Mechanismen im Transplantat wesentlich vorangebracht, insbesondere die antikörpermediierte Rejektion, welche allein mit histologischen Methoden z. T. schwer zu erkennen ist. Mit der Fortentwicklung einhergehende Änderungen der Banff-Klassifikation machen es für die kontinuierliche Pflege von Datenbanken und für Publikationen nötig, die eingeschlossenen Biopsien nach aktuellem Konsensus nach zu beurteilen. Digitale und molekulare Innovationen sowie neue immunologische Mechanismen sind zu erwarten.

Abstract

Renal transplantation represents the best treatment for end-stage renal disease. Much effort has been invested in improvement of longevity of the transplanted organ including a comprehensive and regularly updated histological scoring system (Banff classification) for surveillance; however, survival of transplanted kidneys is still limited to median 15 years. Molecular analyses have increased the understanding of damaging mechanisms within the transplant, especially antibody-mediated rejection, which can be difficult to identify using histological methods. Changes in the Banff classification necessitate to reclassify biopsies included in studies according to current consensus. Digital and molecular innovations as well as new immunologic mechanisms are anticipated.

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  1. Bereichsleitung Nephropathologie, Institut für Pathologie, OE 5110, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    Jan Hinrich Bräsen

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Bräsen, J.H. Aktuelle Aspekte zur Diagnostik an Nierentransplantaten – „Banff and beyond“. Pathologie 43 (Suppl 1), 134–136 (2022). https://doi.org/10.1007/s00292-022-01148-3

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