title: 2013 Banff Criteria for Chronic Active Antibody-Mediated Rejection: Assessment in a Real-Life Setting.
abstract: Significant changes in the criteria for chronic active antibody-mediated rejection (CAABMR) were made in the Banff 2013 classification. These modifications expanded the number of patients diagnosed with CAABMR, with undetermined clinical significance. We compared the 2007 and 2013 criteria for the composite end point of death-censored graft failure or doubling of serum creatinine in 123 patients meeting the criterion related to the morphologic evidence of chronic tissue injury. In all, 18% and 36% of the patients met the 2007 and 2013 criteria, respectively. For the criterion related to antibody interaction with endothelium, only 25% were positive based on the 2007 definition compared with 82% using the 2013 definition. Cox modeling revealed that a 2013 but not a 2007 diagnosis was associated with the composite end point (adjusted hazard ratio 2.5 [95% confidence interval (CI) 1.2-5.2] vs. 1.6 [95% CI 0.7-3.8], respectively). The 2013 criterion based on both the C4d score and the glomerulitis plus peritubular capillaritis score (g+ptc) was more strongly associated with the end point than the 2007 criterion based only on C4d; however, when dissected by component, only the C4d component was significant. The association with clinical outcomes improved with the 2013 criteria. This is related to the new C4d threshold but not to the g+ptc ≥2 component.
authors.affiliation: Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: De Serres
authors.affiliation: Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Noël
authors.affiliation: Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Côté
authors.affiliation: Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Lapointe
authors.affiliation: Immunology and Histocompatibility Laboratory, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Wagner
authors.affiliation: Department of Pathology, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Riopel
authors.affiliation: Department of Pathology, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Latulippe
authors.affiliation: Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Agharazii
authors.affiliation: Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Houde
mesh_terms: D015935:Complement C4b / Q000276:immunology* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies; D015935:Complement C4b