Banff Schema for Grading Liver Allograft Rejection: An International Consensus Document

Abstract

an internationally acceptable grading system, which has al-A panel of recognized experts in liver transplantation ready been developed for kidney, 3 heart, 4 and lung. 5 At the pathology, hepatology, and surgery was convened for Third Banff Conference on Allograft Pathology, a group of the purpose of developing a consensus document for the specialists in liver transplantation from North America, Eugrading of acute liver allograft rejection that is scientifirope, and Asia met for this purpose. cally correct, simple, and reproducible and clinically useful. Over a period of 6 months pertinent issues were DEFINITION OF ACUTE REJECTION discussed via electronic communication media and a consensus conference was held in Banff, Canada in the In general, organ allograft rejection can be defined as, ''an summer of 1995. Based on previously published data and immunological reaction to the presence of a foreign tissue or the combined experience of the group, the panel agreed organ, which has the potential to result in graft dysfunction on a common nomenclature and a set of histopathologi-and failure.'' 2 This report is specifically concerned with acute cal criteria for the grading of acute liver allograft rejec-rejection, recently defined by the international consensus tion, and a preferred method of reporting. Adoption of document on terminology for hepatic allograft rejection 2 as, this internationally accepted, common grading system ''inflammation of the allograft, elicited by a genetic disparity by scientific journals will minimize the problems associ-between the donor and recipient, primarily affecting interlobated with the use of multiple different local systems. ular bile ducts and vascular endothelia, including portal Modifications of this working document to incorporate veins and hepatic venules and occasionally the hepatic artery chronic rejection are expected in the future. (HEPATOL-and its branches.'' 2 Early rejection, cellular rejection, nonduc-OGY 1997;25:658-663.) topenic rejection, rejection without duct loss, and reversible rejection are synonyms for acute rejection that appear in the literature, but their use is discouraged. The general clinical, The success of hepatic transplantation has resulted in its laboratory, and histopathological abnormalities listed below widespread use for treatment of many patients with endstage were derived from the international consensus document.2 liver disease; it is currently offered by more than 100 centers worldwide. One-year survival rates range from 70% to 90%; CLINICAL AND LABORATORY FINDINGSand long-term survival of 50% to 60% of patients is not unViewed from a biological perspective, any recipient's imcommon.1 Therefore, an increasing number of physicians, inmune system will likely be perturbed after transplantation, cluding pathologists, many of whom have no specific training resulting in immune activation. 2 However, viewed from a in transplantation biology, will become involved in the care clinical perspective, because of baseline immunosuppressive of organ all...

Belatacept-Based Immunosuppression in De Novo Liver Transplant Recipients: 1-Year Experience From a Phase II Randomized Study

“…AR was included in the composite end point if it was clinically suspected and proven via biopsy. All biopsies for suspected AR were assessed by a central histopathologist blinded to treatment assignment using the Banff schema for grading of LT rejection and rejection activity index for staging (19). Graft loss was defined as impairment of liver function that resulted in patient death or re-transplantation.…”

Early Trajectories of Depressive Symptoms after Liver Transplantation for Alcoholic Liver Disease Predicts Long-Term Survival

“…Each biopsy is rated on specific features including the presence of fat, bile duct and portal inflammation, venous endothelial inflammation and lobar architecture and inflammation. Acute rejection required both a pathologist’s descriptive report of acute rejection and a rejection activity index score ≥ 3 (7). …”

Th17 promotes acute rejection following liver transplantation in rats

“…The 4-μm sections were stained with hematoxylin and eosin (H&E) for histological examination. Acute allograft rejection was scored with rejection activity index (RAI) according to the Banff 97 working classification of hepatic allograft pathology (Demetrius et al, 1997) by a single-blinded pathologist.…”