A 2018 Reference Guide to the Banff Classification of Renal Allograft Pathology

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Abstract

The Banff Classification of Allograft Pathology is an international consensus classification for the reporting of biopsies from solid organ transplants. Since its initial conception in 1991 for renal transplants, it has undergone review every 2 years, with attendant updated publications. The rapid expansion of knowledge in the field has led to numerous revisions of the classification. The resultant dispersal of relevant content makes it difficult for novices and experienced pathologists to faithfully apply the classification in routine diagnostic work and in clinical trials. This review shall provide a complete and simple illustrated reference guide of the Banff Classification of Kidney Allograft Pathology based on all publications including the 2017 update. It is intended as a concise desktop reference for pathologists and clinicians, providing definitions, Banff Lesion Scores and Banff Diagnostic Categories. An online website reference guide hosted by the Banff Foundation for Allograft Pathology ( www.banfffoundation.org) is being developed, which will be updated with future refinement of the Banff Classification from 2019 onward.

Abstract

The Banff classification is the gold standard in kidney transplantation for both pathologists and clinicians. As this classification is evolving quickly, the authors provide a complete and simple illustrated reference guide to help everyone taking advantage of this growing piece of knowledge. Supplemental digital content is available in the text.

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The Human Cell Atlas

Aviv Regev, Sarah Teichmann, Eric S. Lander … (2017)

The recent advent of methods for high-throughput single-cell molecular profiling has catalyzed a growing sense in the scientific community that the time is ripe to complete the 150-year-old effort to identify all cell types in the human body. The Human Cell Atlas Project is an international collaborative effort that aims to define all human cell types in terms of distinctive molecular profiles (such as gene expression profiles) and to connect this information with classical cellular descriptions (such as location and morphology). An open comprehensive reference map of the molecular state of cells in healthy human tissues would propel the systematic study of physiological states, developmental trajectories, regulatory circuitry and interactions of cells, and also provide a framework for understanding cellular dysregulation in human disease. Here we describe the idea, its potential utility, early proofs-of-concept, and some design considerations for the Human Cell Atlas, including a commitment to open data, code, and community.

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The Banff 97 working classification of renal allograft pathology.

L C Racusen, K Solez, R B Colvin … (1999)

Standardization of renal allograft biopsy interpretation is necessary to guide therapy and to establish an objective end point for clinical trials. This manuscript describes a classification, Banff 97, developed by investigators using the Banff Schema and the Collaborative Clinical Trials in Transplantation (CCTT) modification for diagnosis of renal allograft pathology. Banff 97 grew from an international consensus discussion begun at Banff and continued via the Internet. This schema developed from (a) analysis of data using the Banff classification, (b) publication of and experience with the CCTT modification, (c) international conferences, and (d) data from recent studies on impact of vasculitis on transplant outcome. Semiquantitative lesion scoring continues to focus on tubulitis and arteritis but includes a minimum threshold for interstitial inflammation. Banff 97 defines "types" of acute/active rejection. Type I is tubulointerstitial rejection without arteritis. Type II is vascular rejection with intimal arteritis, and type III is severe rejection with transmural arterial changes. Biopsies with only mild inflammation are graded as "borderline/suspicious for rejection." Chronic/sclerosing allograft changes are graded based on severity of tubular atrophy and interstitial fibrosis. Antibody-mediated rejection, hyperacute or accelerated acute in presentation, is also categorized, as are other significant allograft findings. The Banff 97 working classification refines earlier schemas and represents input from two classifications most widely used in clinical rejection trials and in clinical practice worldwide. Major changes include the following: rejection with vasculitis is separated from tubulointerstitial rejection; severe rejection requires transmural changes in arteries; "borderline" rejection can only be interpreted in a clinical context; antibody-mediated rejection is further defined, and lesion scoring focuses on most severely involved structures. Criteria for specimen adequacy have also been modified. Banff 97 represents a significant refinement of allograft assessment, developed via international consensus discussions.

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The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell–mediated rejection, antibody‐mediated rejection, and prospects for integrative endpoints for next‐generation clinical trials

M. Haas, A Loupy, C Lefaucheur … (2018)

The kidney sessions of the 2017 Banff Conference focused on 2 areas: clinical implications of inflammation in areas of interstitial fibrosis and tubular atrophy (i‐IFTA) and its relationship to T cell–mediated rejection (TCMR), and the continued evolution of molecular diagnostics, particularly in the diagnosis of antibody‐mediated rejection (ABMR). In confirmation of previous studies, it was independently demonstrated by 2 groups that i‐IFTA is associated with reduced graft survival. Furthermore, these groups presented that i‐IFTA, particularly when involving >25% of sclerotic cortex in association with tubulitis, is often a sequela of acute TCMR in association with underimmunosuppression. The classification was thus revised to include moderate i‐IFTA plus moderate or severe tubulitis as diagnostic of chronic active TCMR. Other studies demonstrated that certain molecular classifiers improve diagnosis of ABMR beyond what is possible with histology, C4d, and detection of donor‐specific antibodies (DSAs) and that both C4d and validated molecular assays can serve as potential alternatives and/or complements to DSAs in the diagnosis of ABMR. The Banff ABMR criteria are thus updated to include these alternatives. Finally, the present report paves the way for the Banff scheme to be part of an integrative approach for defining surrogate endpoints in next‐generation clinical trials.

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Author and article information

Journal

Journal ID (nlm-ta): Transplantation

Journal ID (iso-abbrev): Transplantation

Journal ID (publisher-id): TP

Title: Transplantation

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 0041-1337

ISSN (Electronic): 1534-6080

Publication date (Print): November 2018

Publication date (Electronic): 26 October 2018

Volume: 102

Issue: 11

Pages: 1795-1814

Affiliations

[1 ] Department of Medicine, Imperial College, London, United Kingdom.

[2 ] North West London Pathology, London, United Kingdom.

[3 ] Department of Histopathology, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom.

[4 ] Department of Pathology, Erasmus MC, Rotterdam, The Netherlands.

[5 ] Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA.

[6 ] Department of Pathology, University of Chicago, Chicago, IL.

[7 ] Paris Translational Research Center for Organ Transplantation, Paris, France.

[8 ] Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.

[9 ] Department of Transplantology, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.

[10 ] Department of Pathology, Necker Hospital University Paris Descartes, Paris, France.

[11 ] The Johns Hopkins University, Baltimore, MD.

[12 ] Institute of Pathology, University Hospital of Cologne, Cologne, Germany.

Author notes

[*]Correspondence: Jan U. Becker, MD, Institute of Pathology, University Hospital of Cologne, Kerpener Str. 62, 50937, Germany. ( janbecker@ 123456gmx.com ).

Article

Publisher ID: TP501635 Accession ID: 00014

DOI: 10.1097/TP.0000000000002366

PMC ID: 7597974

PubMed ID: 30028786

SO-VID: 512c78c1-8d9a-43ab-8712-2b4102293ea3

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date accepted : 23 May 2018

Date received : 19 February 2018

Date revision received : 7 May 2018

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A 2018 Reference Guide to the Banff Classification of Renal Allograft Pathology

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Most cited references 30

The Human Cell Atlas

The Banff 97 working classification of renal allograft pathology.

The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell–mediated rejection, antibody‐mediated rejection, and prospects for integrative endpoints for next‐generation clinical trials

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