Banff 2022 pancreas transplantation multidisciplinary report: Refinement of guidelines for T cell-mediated rejection, antibody-mediated rejection and islet pathology. Assessment of duodenal cuff biopsies and noninvasive diagnostic methods

Cinthia B Drachenberg; Maike Buettner-Herold; Pedro Ventura Aguiar; Catherine Horsfield; Alexei V Mikhailov; John C Papadimitriou; Surya V Seshan; Marcelo Perosa; Ugo Boggi; Pablo Uva; Michael Rickels; Krzyztof Grzyb; Lois Arend; Miriam Cuatrecasas; Maria Fernanda Toniolo; Alton B Farris; Karine Renaudin; Lizhi Zhang; Candice Roufousse; Angelika Gruessner; Rainer Gruessner; Raja Kandaswamy; Steven White; George Burke; Diego Cantarovich; Ronald F Parsons; Matthew Cooper; Yogish C Kudva; Aleksandra Kukla; Abdolreza Haririan; Sandesh Parajuli; Juan Francisco Merino-Torres; Maria Argente-Pla; Raphael Meier; Ty Dunn; Richard Ugarte; Joseph Sushil Rao; Fabio Vistoli; Robert Stratta; Jon Odorico

doi:10.1016/j.ajt.2023.10.011

Banff 2022 pancreas transplantation multidisciplinary report: Refinement of guidelines for T cell-mediated rejection, antibody-mediated rejection and islet pathology. Assessment of duodenal cuff biopsies and noninvasive diagnostic methods

Am J Transplant. 2024 Mar;24(3):362-379. doi: 10.1016/j.ajt.2023.10.011. Epub 2023 Oct 21.

Authors

Cinthia B Drachenberg¹, Maike Buettner-Herold², Pedro Ventura Aguiar³, Catherine Horsfield⁴, Alexei V Mikhailov⁵, John C Papadimitriou⁶, Surya V Seshan⁷, Marcelo Perosa⁸, Ugo Boggi⁹, Pablo Uva¹⁰, Michael Rickels¹¹, Krzyztof Grzyb¹², Lois Arend¹³, Miriam Cuatrecasas¹⁴, Maria Fernanda Toniolo¹⁵, Alton B Farris¹⁶, Karine Renaudin¹⁷, Lizhi Zhang¹⁸, Candice Roufousse¹⁹, Angelika Gruessner²⁰, Rainer Gruessner²¹, Raja Kandaswamy²², Steven White²³, George Burke²⁴, Diego Cantarovich²⁵, Ronald F Parsons²⁶, Matthew Cooper²⁷, Yogish C Kudva²⁸, Aleksandra Kukla²⁹, Abdolreza Haririan³⁰, Sandesh Parajuli³¹, Juan Francisco Merino-Torres³², Maria Argente-Pla³³, Raphael Meier³⁴, Ty Dunn³⁵, Richard Ugarte³⁰, Joseph Sushil Rao³⁶, Fabio Vistoli⁹, Robert Stratta³⁷, Jon Odorico³⁸

Affiliations

¹ Department of Pathology, University of Maryland School of Medicine, Maryland, USA. Electronic address: [email protected].
² Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Erlangen, Germany.
³ Department of Nephrology, Hospital Clìnic de Barcelona, Barcelona, Spain.
⁴ Department of Histopathology/Cytology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
⁵ Department of Pathology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA.
⁶ Department of Pathology, University of Maryland School of Medicine, Maryland, USA.
⁷ Division of Renal Pathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, New York, USA.
⁸ Beneficência Portuguesa and Bandeirantes Hospital of São Paulo, São Paulo, Brazil.
⁹ Department of Surgery, University of Pisa, Pisa, The province of Pisa, Italy.
¹⁰ Kidney/Pancreas Transplant Program, Instituto de Trasplantes y Alta Complejidad (ITAC - Nephrology), Buenos Aires, Argentina.
¹¹ Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Philadelphia, USA.
¹² Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
¹³ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
¹⁴ Department of Pathology, Hospital Clìnic de Barcelona, Barcelona, Spain.
¹⁵ Centro de Diagnostico Patologico, Buenos Aires, Argentina.
¹⁶ Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁷ Department of Pathology, CHU - Hôtel Dieu, Nantes, France.
¹⁸ Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.
¹⁹ Department of Immunology and Inflammation, Imperial College of London, London, United Kingdom.
²⁰ Department of Nephrology/Medicine, State University of New York, New York, USA.
²¹ Department of Surgery, State University of New York, New York, USA.
²² Division of Solid Organ Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
²³ Department of Surgery, Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, England, United Kingdom.
²⁴ Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
²⁵ Department of Nephrology, CHU - Hôtel Dieu, Nantes, France.
²⁶ Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
²⁷ Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
²⁸ Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
²⁹ Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA.
³⁰ Department of Medicine, University of Maryland School of Medicine, Maryland, USA.
³¹ Department of Medicine, UWHealth Transplant Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
³² Department of Endocrinology and Nutrition, University Hospital La Fe, La Fe Health Research Institute, University of Valencia, Valencia, Spain.
³³ University Hospital La Fe, Health Research Institute La Fe, Valencia, Spain.
³⁴ Department of Surgery, University of Maryland School of Medicine, Maryland, USA.
³⁵ Division of Transplantation, Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Pennsylvania, Philadelphia, USA.
³⁶ Division of Solid Organ Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA; Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
³⁷ Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA.
³⁸ Division of Transplantation, Department of Surgery, UWHealth Transplant Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

PMID: 37871799
DOI: 10.1016/j.ajt.2023.10.011

Abstract

The Banff pancreas working schema for diagnosis and grading of rejection is widely used for treatment guidance and risk stratification in centers that perform pancreas allograft biopsies. Since the last update, various studies have provided additional insight regarding the application of the schema and enhanced our understanding of additional clinicopathologic entities. This update aims to clarify terminology and lesion description for T cell-mediated and antibody-mediated allograft rejections, in both active and chronic forms. In addition, morphologic and immunohistochemical tools are described to help distinguish rejection from nonrejection pathologies. For the first time, a clinicopathologic approach to islet pathology in the early and late posttransplant periods is discussed. This update also includes a discussion and recommendations on the utilization of endoscopic duodenal donor cuff biopsies as surrogates for pancreas biopsies in various clinical settings. Finally, an analysis and recommendations on the use of donor-derived cell-free DNA for monitoring pancreas graft recipients are provided. This multidisciplinary effort assesses the current role of pancreas allograft biopsies and offers practical guidelines that can be helpful to pancreas transplant practitioners as well as experienced pathologists and pathologists in training.

Keywords: acute T cell–mediated rejection; antibody-mediated rejection; donor-specific antibody; mixed rejection; pancreas after kidney transplant; percutaneous pancreas biopsy; simultaneous pancreas kidney transplant; solitary pancreas transplant; whole pancreas transplantation.

MeSH terms

Biopsy
Isoantibodies
Pancreas Transplantation*
T-Lymphocytes
Transplantation, Homologous

Substances

Isoantibodies