Real-time monitoring of acute liver-allograft rejection using the Banff schema.
BACKGROUND
The Banff schema is the internationally accepted standard for grading acute liver-allograft rejection, but it has not been prospectively tested.


METHODS
Complete Banff grading was prospectively applied to 2,038 liver-allograft biopsies from 901 adult tacrolimus-treated primary hepatic allograft recipients between August 1995 and September 2001. Histopathologic data was melded with demographic, clinical, and laboratory data into a database on an ongoing basis using locally developed software.


RESULTS
Acute rejection developed in 575 of 901 (64%) patients and the worst grade was mild in 422 of 575 (73%). At least one episode of moderate or severe acute rejection developed in 153 of 901 (17%) patients and most episodes, irrespective of severity, occurred within the first year after transplantation. Patients with moderate or severe acute rejection showed higher alanine aminotransferase (P =0.007) and aspartate aminotransferase ( P=0.07) levels and were more likely to develop perivenular fibrosis on follow-up biopsies (P =0.001) and graft failure from acute or chronic rejection ( P=0.004) than those with mild rejection. Regardless of severity, 80% of patients with acute rejection did not develop significant fibrosis in follow-up biopsies, and graft failure from acute or chronic rejection occurred in only 11 of 901 (1%) allografts.


CONCLUSIONS
Most acute-rejection episodes are mild and do not lead to clinically significant architectural sequelae. When tested prospectively under real-life and -time conditions, the Banff schema can be used to identify those few patients who are potentially at risk for more significant problems. Creation, capture, and integration of non-free text, or "digital," pathology data can be used to prospectively conduct outcomes-based research in transplantation.
Demetris
A J
AJ
Department of Pathology, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. demetrisaj@msx.upmc.edu.
Ruppert
K
K
Dvorchik
I
I
Jain
A
A
Minervini
M
M
Nalesnik
M A
MA
Randhawa
P
P
Wu
T
T
Zeevi
A
A
Abu-Elmagd
K
K
Eghtesad
B
B
Fontes
P
P
Cacciarelli
T
T
Marsh
W
W
Geller
D
D
Fung
J J
JJ
D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D002908:Chronic Disease; D003199:Computer Systems; D006084:Graft Rejection / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects*; D010336:Pathology / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014184:Transplantation, Homologous