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Am J Transplant. 2017 Jan;17(1):28-41. doi: 10.1111/ajt.14107.

The Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology.

Author information

1
Paris Translational Research Center for Organ Transplantation INSERM U970 & Necker Hospital University Paris Descartes, Paris, France.
2
Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
3
Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.
4
Department of Laboratory Medicine and Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
5
Paris Translational Research Center for Organ Transplantation & Department of Nephrology and Transplantation, Hopital Saint Louis, Université Paris VII and INSERM U 1160, Paris, France.
6
Nephrology Department, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
7
Department of Renal Medicine, Westmead Hospital, Sydney, Australia.
8
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
9
Departments of Pathology & Internal Medicine, University of Texas Medical Branch, Galveston, TX.
10
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
11
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
12
Institute of Pathology, University Hospital of Cologne, Cologne, Germany.
13
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
14
University of Maryland School of Medicine, Baltimore, MD.
15
Berlin Institute of Health and Department of Nephrology and Critical Care Medicine, Charité Universitätsmedizin, Berlin, Germany.
16
Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
17
Department of Pathology, University of Manitoba, Winnipeg, Canada.
18
Department of Pathology & Immunology, Washington University, St. Louis, MO.
19
Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
20
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC.
21
Division of Transplantation Pathology, The Thomas E Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA.
22
Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA.
23
Department of Cellular Pathology, Hammersmith Hospital, London, UK.
24
Department of Pathology, Weill Cornell Medicine, New York, NY.
25
Division of Nephrology, Mayo Clinic, Rochester, MN.
26
Comprehensive Transplant Center, Transplant Immunology Laboratory, Northwestern University, Chicago, IL.
27
University of Pittsburgh Medical Center, Pittsburgh, PA.

Abstract

The XIII Banff meeting, held in conjunction the Canadian Society of Transplantation in Vancouver, Canada, reviewed the clinical impact of updates of C4d-negative antibody-mediated rejection (ABMR) from the 2013 meeting, reports from active Banff Working Groups, the relationships of donor-specific antibody tests (anti-HLA and non-HLA) with transplant histopathology, and questions of molecular transplant diagnostics. The use of transcriptome gene sets, their resultant diagnostic classifiers, or common key genes to supplement the diagnosis and classification of rejection requires further consensus agreement and validation in biopsies. Newly introduced concepts include the i-IFTA score, comprising inflammation within areas of fibrosis and atrophy and acceptance of transplant arteriolopathy within the descriptions of chronic active T cell-mediated rejection (TCMR) or chronic ABMR. The pattern of mixed TCMR and ABMR was increasingly recognized. This report also includes improved definitions of TCMR and ABMR in pancreas transplants with specification of vascular lesions and prospects for defining a vascularized composite allograft rejection classification. The goal of the Banff process is ongoing integration of advances in histologic, serologic, and molecular diagnostic techniques to produce a consensus-based reporting system that offers precise composite scores, accurate routine diagnostics, and applicability to next-generation clinical trials.

KEYWORDS:

clinical research/practice; kidney transplantation/nephrology; organ transplantation in general; pathology/histopathology; rejection; rejection: T cell mediated (TCMR); rejection: antibody-mediated (ABMR); rejection: subclinical; translational research/science

PMID:
27862883
PMCID:
PMC5363228
DOI:
10.1111/ajt.14107
[Indexed for MEDLINE]
Free PMC Article

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