Welcome to the second episode of Banff and Beyond as we begin to discuss transplant cases and dive into the world of transplant rejection. The patient is a 45 y/o male status-post transplant who presents with elevated creatinine. The biopsy demonstrates features compatible with borderline T-cell mediated rejection as it shows interstitial inflammation comprising approximately 10-15% of the unscarred cortex (Banff score: I1) along with mild lymphocytic tubulitis within non-atrophic tubules (Banff score: T1). Of note, tubulitis is ideally graded in tubules cut in cross-section. However, if a longitudinally cut tubule is used, it is scored as the number of mononuclear cells per ten tubular epithelial cells. Additionally, one should not evaluate severely atrophic tubules when assessing for tubulitis including those with endocrine type atrophy, a diameter of less than 25% of the unaffected tubules, and those with pronounced basement membrane wrinkling or thickening.
For reference categories of interstitial inflammation scores and tubulitis scores as follows, respectively:
I0 (<10%), I1 (10-25%), I2 (26-50%), I3 (>50%)
T1 (1-4 cells), T2 (5-10 cells), and T3 (>10 cells)
Quick note: This post is to be used for informational purposes only and does not constitute medical or health advice. Each person should consult their own doctor with respect to matters referenced. Arkana Laboratories assumes no liability for actions taken in reliance upon the information contained herein.
