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

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.

Results of Questionnaire Survey of Current Immune Monitoring Practice of Transplant Clinicians and Clinical Pathologists in Korea: Basis for Establishment of Harmonized Immune Monitoring Guidelines

“…And it is continuously reflected on diagnostic criteria such as Banff criteria (19,20). However, the diagnostic criteria does not specify the practical way of immune monitoring in real world, so, there is no standardized guidelines and is rather institute-or clinician-based protocols.…”

“…Questionnaire surveys designed to identify the current practi- Until now, the immunological monitoring of alloimmune responses are focused on the detection of rejection events in practice than detection of adverse immune activity which might be preceded clinically or pathologically evident rejection signs. It might be rather because there were no reliable and well validated laboratory methods to be applicable.However, luminex bead technologies used for the detection of antibodies in antigen, allele or epitope levels for HLA(7-9) and non-HLA systems(15), and molecular technologies to detect transcript signatures of diverse immunologic changes are broadening our choice of tests(16-18).And it is continuously reflected on diagnostic criteria such as Banff criteria (19,20). However, the diagnostic criteria does not specify the practical way of immune monitoring in real world, so, there is no standardized guidelines and is …”

“…10). In Banff diagnostic criteria, the extent of DSA includes not only to HLA but also to non-HLA antigens (19,20 (24%, 4/17) with grant or agreed that the non-HLA antibody test was necessary in clinical practice (77%, 13/17) (Fig. 10).…”

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“…6,7,10,[17][18][19] The reported rates of de novo TMA vary from 1.1% to 14%. [4][5][6][7][8][9][10][11][12][13][14][15] As we observed, the incidence of Escherichia coliassociated typical hemolytic uremic syndrome is significantly low in renal transplant patients. 3,7 Renal transplant patients with TMA usually do not have systemic signs of hemolytic uremic syndrome.…”

“…3,6,11,12 Detection of C4d expression in renal allograft biopsies is an essential tool, particularly for diagnosis of AMR. 13,14 The incidence of TMA in recipients with AMR has been reported to range from 4% to 46%, with the highest frequency shown in the early posttransplant period. [1][2][3][4][5][6]7,10,15 Glomerular and arteriolar thrombi in renal transplant biopsies with the diagnosis of AMR and chronic antibodymediated rejection are frequently reported, whereas reports of presence of peritubular capillary (PTC) thrombi are scarce.…”