Antibody-mediated rejection (ABMR) is an important cause of both short- and long-term injury to renal allografts. Transplant glomerulopathy (TG) is strongly associated with ABMR and reduced graft survival. Ultrastructural changes in early-stage ABMR include TG as a duplication of the glomerular basement membrane (GBM), which can be observed only by transmission electron microscopy (TEM). Low-vacuum scanning electron microscopy (LVSEM) is a new technique that allows comparatively inexpensive, rapid, and convenient observations with high magnification. We analyzed human renal transplants using LVSEM and evaluated the ultrastructural changes representing TG in ABMR. GBM duplication was more clearly visible in the LVSEM images than in the light microscopy (LM) images. In the ABMR group, the cg score of the Banff classification was higher in 54% (7/13) of specimens for LVSEM images than for LM images. And 4 specimens exhibited duplication of the GBM analyzed by LVSEM, but not by LM. In addition, three-dimensional ultrastructural changes, such as coarse meshwork structures of GBM, were observed in ABMR specimens. The ABMR group also exhibited ultrastructural changes in the peritubular capillary basement membranes. In conclusion, analyses of renal transplant tissues using LVSEM allows the identification of GBM duplication and ultrastructural changes of basement membranes at the electron microscopic level, and is useful for early-stage diagnosis of ABMR.

中文翻译：

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低真空扫描电镜可以早期诊断人肾移植抗体介导的排斥反应。

抗体介导的排斥反应（ABMR）是肾脏同种异体移植短期和长期损伤的重要原因。移植肾小球病变（TG）与ABMR和移植物存活率降低密切相关。早期ABMR的超微结构变化包括TG，它是肾小球基底膜（GBM）的复制，只有通过透射电子显微镜（TEM）才能观察到。低真空扫描电子显微镜（LVSEM）是一项新技术，可实现相对便宜，快速和方便的高倍观察。我们使用LVSEM分析了人类的肾脏移植，并评估了代表ABMR中TG的超微结构变化。GBM复制在LVSEM图像中比在光学显微镜（LM）图像中更清晰可见。在ABMR组中，对于LVSEM图像，Banff分类的cg分数在54％（7/13）的样本中高于LM图像。LVSEM分析了4个标本的GBM，而LM则没有。此外，在ABMR标本中观察到三维超微结构变化，例如GBM的粗网状结构。ABMR组在肾小管周围毛细血管基底膜上也表现出超微结构变化。总之，使用LVSEM分析肾移植组织可以在电子显微镜水平上鉴定GBM复制和基底膜的超微结构变化，对ABMR的早期诊断很有用。在ABMR标本中观察到三维超微结构变化，例如GBM的粗网格结构。ABMR组在肾小管周围毛细血管基底膜上也表现出超微结构变化。总之，使用LVSEM分析肾移植组织可以在电子显微镜下鉴定GBM复制和基底膜的超微结构变化，对ABMR的早期诊断很有用。在ABMR标本中观察到三维超微结构变化，例如GBM的粗网格结构。ABMR组在肾小管周围毛细血管基底膜上也表现出超微结构变化。总之，使用LVSEM分析肾移植组织可以在电子显微镜水平上鉴定GBM复制和基底膜的超微结构变化，对ABMR的早期诊断很有用。