Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 17, Issue 1, Pages 28-41Publisher
WILEY-BLACKWELL
DOI: 10.1111/ajt.14107
Keywords
clinical research; practice; translational research; science; kidney transplantation; nephrology; pathology; histopathology; organ transplantation in general; rejection; rejection: antibody-mediated (ABMR); rejection: subclinical; rejection: T cell mediated (TCMR)
Categories
Funding
- Roche Organ Transplantation Research Foundation [608390948]
- Astellas
- Alexion
- Novartis
- One Lambda
- Renal Pathology Society
- American Society of Transplantation
- Wiley
- Qiagen
- Canadian Institute for Health Research
- Immucor
- Bridge to Life
- Organ Recovery Systems
- Transplant Connect
- Glycorex Transplantation
- Transpath Inc.
- University of Alberta
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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. In this article, the Banff consortium presents the most updated version of the kidney, pancreas, and VCA transplant rejection classification and prospects for implementing intragraft molecular assessment. See the companion report on page 42.
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