The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials

M Haas; A Loupy; C Lefaucheur; C Roufosse; D Glotz; D Seron; B J Nankivell; P F Halloran; R B Colvin; Enver Akalin; N Alachkar; S Bagnasco; Y Bouatou; J U Becker; L D Cornell; J P Duong van Huyen; I W Gibson; Edward S Kraus; R B Mannon; M Naesens; V Nickeleit; P Nickerson; D L Segev; H K Singh; M Stegall; P Randhawa; L Racusen; K Solez; M Mengel

doi:10.1111/ajt.14625

The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials

Am J Transplant. 2018 Feb;18(2):293-307. doi: 10.1111/ajt.14625. Epub 2018 Jan 21.

Authors

M Haas¹, A Loupy², C Lefaucheur³, C Roufosse⁴, D Glotz³, D Seron⁵, B J Nankivell⁶, P F Halloran⁷, R B Colvin⁸, Enver Akalin⁹, N Alachkar¹⁰, S Bagnasco¹¹, Y Bouatou^{2

12}, J U Becker¹³, L D Cornell¹⁴, J P Duong van Huyen², I W Gibson¹⁵, Edward S Kraus¹⁶, R B Mannon¹⁷, M Naesens¹⁸, V Nickeleit¹⁹, P Nickerson²⁰, D L Segev²¹, H K Singh¹⁹, M Stegall²², P Randhawa²³, L Racusen¹¹, K Solez²⁴, M Mengel²⁴

Affiliations

¹ Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
² Paris Translational Research Center for Organ Transplantation, INSERM U970 and Necker Hospital, University Paris Descartes, Paris, France.
³ Paris Translational Research Center for Organ Transplantation and Department of Nephrology and Transplantation, Hopital Saint Louis, Université Paris VII and INSERM U 1160, Paris, France.
⁴ Department of Medicine, Imperial College London and North West London Pathology, London, UK.
⁵ Nephrology Department, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
⁶ Department of Renal Medicine, Westmead Hospital, Sydney, Australia.
⁷ Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, Alberta, Canada.
⁸ Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA.
¹⁰ Department of Medicine, Section of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹¹ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹² Division of Nephrology, Department of Medical Specialities, Geneva University Hospitals, Geneva, Switzerland.
¹³ Institute of Pathology, University Hospital of Cologne, Cologne, Germany.
¹⁴ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
¹⁵ Department of Pathology, University of Manitoba, Winnipeg, Canada.
¹⁶ Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
¹⁷ Division of Nephrology, Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA.
¹⁸ Department of Microbiology and Immunology, University of Leuven & Department of Nephrology, University Hospitals Leuven, Leuven, Belgium.
¹⁹ Division of Nephropathology, Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC, USA.
²⁰ Department of Internal Medicine and Immunology, University of Manitoba, Winnipeg, Canada.
²¹ Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
²² Departments of Surgery and Immunology, Mayo Clinic, Rochester, MN, USA.
²³ Division of Transplantation Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA.
²⁴ Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada.

Abstract

The kidney sessions of the 2017 Banff Conference focused on 2 areas: clinical implications of inflammation in areas of interstitial fibrosis and tubular atrophy (i-IFTA) and its relationship to T cell-mediated rejection (TCMR), and the continued evolution of molecular diagnostics, particularly in the diagnosis of antibody-mediated rejection (ABMR). In confirmation of previous studies, it was independently demonstrated by 2 groups that i-IFTA is associated with reduced graft survival. Furthermore, these groups presented that i-IFTA, particularly when involving >25% of sclerotic cortex in association with tubulitis, is often a sequela of acute TCMR in association with underimmunosuppression. The classification was thus revised to include moderate i-IFTA plus moderate or severe tubulitis as diagnostic of chronic active TCMR. Other studies demonstrated that certain molecular classifiers improve diagnosis of ABMR beyond what is possible with histology, C4d, and detection of donor-specific antibodies (DSAs) and that both C4d and validated molecular assays can serve as potential alternatives and/or complements to DSAs in the diagnosis of ABMR. The Banff ABMR criteria are thus updated to include these alternatives. Finally, the present report paves the way for the Banff scheme to be part of an integrative approach for defining surrogate endpoints in next-generation clinical trials.

Keywords: classification systems: Banff classification; kidney transplantation/nephrology; molecular biology; pathology/histopathology; rejection; translational research/science.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Graft Rejection / diagnosis*
Graft Rejection / etiology
Graft Rejection / pathology
High-Throughput Nucleotide Sequencing / methods*
Humans
Inflammation / diagnosis*
Inflammation / etiology
Inflammation / pathology
Isoantibodies / immunology*
Kidney Transplantation / adverse effects*
Postoperative Complications*
Prognosis
Research Report
T-Lymphocytes / immunology*

Substances

Isoantibodies