BACKGROUND: Standardization of renal allograft biopsy interpretation is necessary to guide therapy and to establish an objective end point for clinical trials. This manuscript describes a classification, Banff 97, developed by investigators using the Banff Schema and the Collaborative Clinical Trials in Transplantation (CCTT) modification for diagnosis of renal allograft pathology. METHODS: Banff 97 grew from an international consensus discussion begun at Banff and continued via the Internet. This schema developed from (a) analysis of data using the Banff classification, (b) publication of and experience with the CCTT modification, (c) international conferences, and (d) data from recent studies on impact of vasculitis on transplant outcome. RESULTS: Semiquantitative lesion scoring continues to focus on tubulitis and arteritis but includes a minimum threshold for interstitial inflammation. Banff 97 defines "types" of acute/active rejection. Type I is tubulointerstitial rejection without arteritis. Type II is vascular rejection with intimal arteritis, and type III is severe rejection with transmural arterial changes. Biopsies with only mild inflammation are graded as "borderline/suspicious for rejection." Chronic/sclerosing allograft changes are graded based on severity of tubular atrophy and interstitial fibrosis. Antibody-mediated rejection, hyperacute or accelerated acute in presentation, is also categorized, as are other significant allograft findings. CONCLUSIONS: The Banff 97 working classification refines earlier schemas and represents input from two classifications most widely used in clinical rejection trials and in clinical practice worldwide. Major changes include the following: rejection with vasculitis is separated from tubulointerstitial rejection; severe rejection requires transmural changes in arteries; "borderline" rejection can only be interpreted in a clinical context; antibody-mediated rejection is further defined, and lesion scoring focuses on most severely involved structures. Criteria for specimen adequacy have also been modified. Banff 97 represents a significant refinement of allograft assessment, developed via international consensus discussions.
BACKGROUND: Standardization of renal allograft biopsy interpretation is necessary to guide therapy and to establish an objective end point for clinical trials. This manuscript describes a classification, Banff 97, developed by investigators using the Banff Schema and the Collaborative Clinical Trials in Transplantation (CCTT) modification for diagnosis of renal allograft pathology. METHODS: Banff 97 grew from an international consensus discussion begun at Banff and continued via the Internet. This schema developed from (a) analysis of data using the Banff classification, (b) publication of and experience with the CCTT modification, (c) international conferences, and (d) data from recent studies on impact of vasculitis on transplant outcome. RESULTS: Semiquantitative lesion scoring continues to focus on tubulitis and arteritis but includes a minimum threshold for interstitial inflammation. Banff 97 defines "types" of acute/active rejection. Type I is tubulointerstitial rejection without arteritis. Type II is vascular rejection with intimal arteritis, and type III is severe rejection with transmural arterial changes. Biopsies with only mild inflammation are graded as "borderline/suspicious for rejection." Chronic/sclerosing allograft changes are graded based on severity of tubular atrophy and interstitial fibrosis. Antibody-mediated rejection, hyperacute or accelerated acute in presentation, is also categorized, as are other significant allograft findings. CONCLUSIONS: The Banff 97 working classification refines earlier schemas and represents input from two classifications most widely used in clinical rejection trials and in clinical practice worldwide. Major changes include the following: rejection with vasculitis is separated from tubulointerstitial rejection; severe rejection requires transmural changes in arteries; "borderline" rejection can only be interpreted in a clinical context; antibody-mediated rejection is further defined, and lesion scoring focuses on most severely involved structures. Criteria for specimen adequacy have also been modified. Banff 97 represents a significant refinement of allograft assessment, developed via international consensus discussions.
Authors: Simone A Joosten; Mieneke G A van Dixhoorn; Maria C Borrias; Hallgrimur Benediktsson; Peter A van Veelen; Cees van Kooten; Leendert C Paul Journal: Am J Pathol Date: 2002-04 Impact factor: 4.307
Authors: Putri A Agustian; Mario Schiffer; Wilfried Gwinner; Irini Schäfer; Katharina Theophile; Friedrich Modde; Clemens L Bockmeyer; Jana Traeder; Ulrich Lehmann; Anika Grosshennig; Hans H Kreipe; Verena Bröcker; Jan U Becker Journal: Am J Pathol Date: 2011-05 Impact factor: 4.307
Authors: W Wong; J DeVito; H Nguyen; D Sarracino; F Porcheray; I Dargon; P D Pelle; A B Collins; N Tolkoff-Rubin; R N Smith; R Colvin; E Zorn Journal: Am J Transplant Date: 2010-11 Impact factor: 8.086
Authors: Thomas E Starzl; Noriko Murase; Kareem Abu-Elmagd; Edward A Gray; Ron Shapiro; Bijan Eghtesad; Robert J Corry; Mark L Jordan; Paulo Fontes; Tim Gayowski; Geoffrey Bond; Velma P Scantlebury; Santosh Potdar; Parmjeet Randhawa; Tong Wu; Adriana Zeevi; Michael A Nalesnik; Jennifer Woodward; Amadeo Marcos; Massimo Trucco; Anthony J Demetris; John J Fung Journal: Lancet Date: 2003-05-03 Impact factor: 79.321