title: The Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology.
abstract: 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.
authors.affiliation: Paris Translational Research Center for Organ Transplantation INSERM U970 & Necker Hospital University Paris Descartes, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Loupy
authors.affiliation: Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: M
authors.initials: M
authors.lastname: Haas
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Solez
authors.affiliation: Department of Laboratory Medicine and Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: L
authors.initials: L
authors.lastname: Racusen
authors.affiliation: Paris Translational Research Center for Organ Transplantation & Department of Nephrology and Transplantation, Hopital Saint Louis, Université Paris VII and INSERM U 1160, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Glotz
authors.affiliation: Nephrology Department, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
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authors.initials: D
authors.lastname: Seron
authors.affiliation: Department of Renal Medicine, Westmead Hospital, Sydney, Australia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Nankivell
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: R B
authors.initials: RB
authors.lastname: Colvin
authors.affiliation: Departments of Pathology & Internal Medicine, University of Texas Medical Branch, Galveston, TX.
authors.forename: M
authors.initials: M
authors.lastname: Afrouzian
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: E
authors.initials: E
authors.lastname: Akalin
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: N
authors.initials: N
authors.lastname: Alachkar
authors.affiliation: Department of Laboratory Medicine and Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: S
authors.initials: S
authors.lastname: Bagnasco
authors.affiliation: Institute of Pathology, University Hospital of Cologne, Cologne, Germany.
authors.forename: J U
authors.initials: JU
authors.lastname: Becker
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors.forename: L
authors.initials: L
authors.lastname: Cornell
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD.
authors.forename: C
authors.initials: C
authors.lastname: Drachenberg
authors.affiliation: Berlin Institute of Health and Department of Nephrology and Critical Care Medicine, Charité Universitätsmedizin, Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Dragun
authors.affiliation: Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: H
authors.identifier: 0000-0003-3601-532X
authors.initials: H
authors.lastname: de Kort
authors.affiliation: Department of Pathology, University of Manitoba, Winnipeg, Canada.
authors.forename: I W
authors.initials: IW
authors.lastname: Gibson
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: E S
authors.initials: ES
authors.lastname: Kraus
authors.affiliation: Paris Translational Research Center for Organ Transplantation & Department of Nephrology and Transplantation, Hopital Saint Louis, Université Paris VII and INSERM U 1160, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Lefaucheur
authors.affiliation: Paris Translational Research Center for Organ Transplantation INSERM U970 & Necker Hospital University Paris Descartes, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Legendre
authors.affiliation: Department of Pathology & Immunology, Washington University, St. Louis, MO.
authors.forename: H
authors.initials: H
authors.lastname: Liapis
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
authors.forename: T
authors.initials: T
authors.lastname: Muthukumar
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: V
authors.initials: V
authors.lastname: Nickeleit
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: B
authors.initials: B
authors.lastname: Orandi
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors.forename: W
authors.initials: W
authors.lastname: Park
authors.affiliation: Paris Translational Research Center for Organ Transplantation INSERM U970 & Necker Hospital University Paris Descartes, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Rabant
authors.affiliation: Division of Transplantation Pathology, The Thomas E Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: P
authors.initials: P
authors.lastname: Randhawa
authors.affiliation: Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA.
authors.forename: E F
authors.initials: EF
authors.lastname: Reed
authors.affiliation: Department of Cellular Pathology, Hammersmith Hospital, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Roufosse
authors.affiliation: Department of Pathology, Weill Cornell Medicine, New York, NY.
authors.forename: S V
authors.initials: SV
authors.lastname: Seshan
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Sis
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: H K
authors.initials: HK
authors.lastname: Singh
authors.affiliation: Division of Nephrology, Mayo Clinic, Rochester, MN.
authors.forename: C
authors.initials: C
authors.lastname: Schinstock
authors.affiliation: Comprehensive Transplant Center, Transplant Immunology Laboratory, Northwestern University, Chicago, IL.
authors.forename: A
authors.initials: A
authors.lastname: Tambur
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: A
authors.initials: A
authors.lastname: Zeevi
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Mengel
mesh_terms: D001167:Arteritis / Q000276:immunology*; D015935:Complement C4b / Q000276:immunology*; D006084:Graft Rejection / Q000145:classification* / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D010446:Peptide Fragments / Q000276:immunology*; D058028:Research Report
chemical_list: D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d
keywords: clinical research/practice; kidney transplantation/nephrology; organ transplantation in general; pathology/histopathology; rejection; rejection: T cell mediated (TCMR); rejection: antibody-mediated (ABMR); rejection: subclinical; translational research/science