2013 Banff Criteria for Chronic Active Antibody-Mediated Rejection: Assessment in a Real-Life Setting

Abstract

Significant changes in the criteria for chronic active antibody-mediated rejection (CAABMR) were made in the Banff 2013 classification. These modifications expanded the number of patients diagnosed with CAABMR, with undetermined clinical significance. We compared the 2007 and 2013 criteria for the composite end point of death-censored graft failure or doubling of serum creatinine in 123 patients meeting the criterion related to the morphologic evidence of chronic tissue injury. In all, 18% and 36% of the patients met the 2007 and 2013 criteria, respectively. For the criterion related to antibody interaction with endothelium, only 25% were positive based on the 2007 definition compared with 82% using the 2013 definition. Cox modeling revealed that a 2013 but not a 2007 diagnosis was associated with the composite end point (adjusted hazard ratio 2.5 [95% confidence interval (CI) 1.2-5.2] vs. 1.6 [95% CI 0.7-3.8], respectively). The 2013 criterion based on both the C4d score and the glomerulitis plus peritubular capillaritis score (g+ptc) was more strongly associated with the end point than the 2007 criterion based only on C4d; however, when dissected by component, only the C4d component was significant. The association with clinical outcomes improved with the 2013 criteria. This is related to the new C4d threshold but not to the g+ptc ≥2 component.

Chronic-active antibody-mediated rejection with or without donor-specific antibodies has similar histomorphology and clinical outcome - a retrospective study

“…The presence of DSA was not associated with a difference in response to therapy or graft survival. The latter finding is in accordance with previous studies that did not show a significant impact of DSA on renal allograft survival in transplant patients with evidence for antibody-mediated rejection either acute or chronic [14,15,18,24]. In addition, remarkably similar clinical characteristics and no differences in the renal allograft histomorphology were observed between the DSApos and DSAneg cases.…”

“…A median of 21 glomeruli (18-32) was available per biopsy for the DSApos group of which 13% (5-20%) was globally sclerotic. For the DSAneg group, a median of 13 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) glomeruli was available of which 8% (2-17%) was globally sclerotic. Although the total number of glomeruli was significantly different (P = 0.02) between the groups, this was not the case for the percentage of global glomerulosclerosis (P = 0.22).…”

“…This diagnosis leaves clinicians uncertain about the accuracy of the diagnosis and treatment options for these DSA-negative cases, as previously reported by Halloran et al [14]. Furthermore, those cases classified as suspicious for c-aABMR are frequently excluded from clinical trials, resulting in scarce data about the clinical significance of DSA seropositivity [15][16][17][18].…”

“…. Furthermore, those cases classified as suspicious for c‐aABMR are frequently excluded from clinical trials, resulting in scarce data about the clinical significance of DSA seropositivity .…”

Acute Rejection Phenotypes in the Current Era of Immunosuppression: A Single-Center Analysis

“…Third, the use of 16-gauge needles for biopsies and immunofluorescence for C4d detection reduces sampling error and increases sensitivity for accurate diagnosis of rejection. 54 Fourth, the assignment of the Banff diagnosis was performed by a computer-based calculation allowing us to strictly follow the Banff classification rules. Fifth, the vast majority of biopsies were evaluated by the same pathologist minimizing interobserver variability.…”