Banff 2013 Meeting Report: Inclusion of C4d-Negative Antibody-Mediated Rejection and Antibody-Associated Arterial Lesions

Haas, Mark; Sis, B.; Racusen, Lorraine C.; Solez, Kim; Glotz, Denis; Colvin, Robert B.; Castro, Maria Cristina Ribeiro de; David, Débora Leite; David‐Neto, Elias; Bagnasco, Serena M.; Cendales, Linda C.; Cornell, Lynn D.; Demetris, A. J.; Drachenberg, Cinthia B.; Farver, Carol; Farris, Alton B.; Gibson, Ian W.; Kraus, Edward S.; Liapis, Helen; Loupy, Alexandre; Nickeleit, Volker; Randhawa, Parmjeet; Rodríguez, E. René; Rush, David; Smith, Rex Neal; Tan, Carmela D.; Wallace, W. Dean; Mengel, Michael

doi:10.1111/ajt.12590

Cited by 1,248 publications

(1,263 citation statements)

References 38 publications

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“…As part of the 2013 revision of the Banff classification for diagnosing ABMR, molecular assessment of transcripts indicative of endothelial injury in the renal allograft biopsy was added as a potential diagnostic criterion 1; however, there is no consensus on which transcripts are diagnostic or on the criteria for positivity. Standards for platforms, methods, and reproducibility for such molecular diagnostic assays have not yet been set; such standards are a requirement for robust clinical validation and adoption in diagnostic pathology laboratories.…”

Section: Prospects For Adopting Molecular Pathology In Renal Allografmentioning

confidence: 99%

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

Loupy

Haas

Solez

et al. 2017

American Journal of Transplantation

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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.

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Section: Prospects For Adopting Molecular Pathology In Renal Allografmentioning

confidence: 99%

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

Loupy

Haas

Solez

et al. 2017

American Journal of Transplantation

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567

581

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“…1 and 2. They include arteritis, as defined by the Banff component v, transplant glomerulitis (Banff component g), peritubular capillaritis (Banff component ptc), microthrombosis without any other cause and C4d positivity of the peritubular capillary endothelium (Banff component C4d) [5]. The addition of arteritis, or vascular rejection, to the criteria for acute antibody-mediated rejection was stimulated by a recent cluster analysis in a large cohort of patients from France that identified a humoral component in about two-thirds of patients with arteritis [6].…”

Section: Histopathological Diagnosis Of Acute Antibody-mediated Rejecmentioning

confidence: 99%

“…The addition of arteritis, or vascular rejection, to the criteria for acute antibody-mediated rejection was stimulated by a recent cluster analysis in a large cohort of patients from France that identified a humoral component in about two-thirds of patients with arteritis [6]. This and also the recognition of C4d-negative acute antibody-mediated rejection in about 20-40 % of cases remain about the only merits of the new Banff guidelines [5]. The exact definition of the Banff component g (transplant glomerulitis), although long overdue, has been designed to maximize reproducibility and correlation with mRNA transcriptome changes closely linked with tubulointerstitial rejection on only 47 biopsies; a correlation with outcome was not sought [5].…”

Section: Histopathological Diagnosis Of Acute Antibody-mediated Rejecmentioning

confidence: 99%

“…This and also the recognition of C4d-negative acute antibody-mediated rejection in about 20-40 % of cases remain about the only merits of the new Banff guidelines [5]. The exact definition of the Banff component g (transplant glomerulitis), although long overdue, has been designed to maximize reproducibility and correlation with mRNA transcriptome changes closely linked with tubulointerstitial rejection on only 47 biopsies; a correlation with outcome was not sought [5]. This and also the change of the threshold between g2 and g3 from previously 75 % [7,8] to now 50 % involved glomeruli without announcement is problematic in our view.…”

Section: Histopathological Diagnosis Of Acute Antibody-mediated Rejecmentioning

confidence: 99%

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Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

et al. 2014

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Acute antibody-mediated rejection is a diagnostic challenge in renal transplantation medicine. However, it is an important diagnosis to make, since chronic antibody-mediated rejection (CAMR) is the main cause of long-term graft loss. Antibody-mediated rejection is diagnosed by detecting donorspecific antibodies (DSAs) in the blood in combination with observing typical histomorphological signs in kidney biopsy, as described in the Banff classification. Therapy is based on the removal of DSAs by administering intravenous immunoglobulins (IVIGs), plasmapheresis, or immunoadsorption. Reoccurrence of antibodies is diminished by the use of rituximab, increased immunosuppression, and in some cases additional experimental substances. A combination of these techniques has been shown to be successful in the majority of cases of acute and chronic antibody-mediated rejection. Routine DSA monitoring is warranted for early detection of antibody-mediated rejection.

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“…Furthermore, ANCA-associated glomerulonephritis sometimes involves perivascular capillaritis. In a while, according to Banff 2013 meeting report, antibody-mediated rejection could occur despite of the negativity of C4d stain [14]. In this case, the specimen also revealed severe peritubular capillaritis, but we did not identify the other changes found in acute/active and chronic active antibody-mediated rejection.…”

Section: Discussionmentioning

confidence: 56%

De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation

et al. 2014

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A 61-year-old woman was admitted to our hospital because of an unexpected rise in serum creatinine (sCr) level with proteinuria and microhematuria. She had undergone living-donor kidney transplantation 31 years before for end-stage renal disease caused by chronic glomerulonephritis (GN). On admission, her sCr was 1.27 mg/ dL which was increased from 0.6 mg/dL, urinary protein/ creatinine ratio was 1.39 g/gCr, and urinary red blood cell count was more than 100 per high power field. The allograft biopsy revealed crescentic glomerulonephritis with moderate to severe tubulointerstitial inflammation. Immunofluorescence staining yielded only a minimal staining for immunoglobulin A, and negative C4d in peritubular capillary. Since increased myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titer of 45.5 U/mL was detected, we made the diagnosis of post-transplant MPO-ANCA-associated GN. She was treated with three doses of bolus methylprednisolone (500 mg) followed by oral prednisolone therapy. Her sCr was stable at 1.20 mg/ dL thereafter. ANCA-associated GN should be considered in older kidney transplant patients with new-onset urinary abnormalities because typical systemic symptoms and vasculitis in other organs might be masked by maintenance immunosuppression.

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Banff 2013 Meeting Report: Inclusion of C4d-Negative Antibody-Mediated Rejection and Antibody-Associated Arterial Lesions

Cited by 1,248 publications

References 38 publications

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

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

Acute and chronic antibody-mediated rejection in pediatric kidney transplantation

De novo myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated glomerulonephritis 31 years after living-donor kidney transplantation

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