Update der Banff-Klassifikation

Der Nephrologe 11/2010; 5(6):494-500. DOI: 10.1007/s11560-009-0378-5

ABSTRACT Die Banff-Arbeitsgruppe repräsentiert internationalen und multidisziplinären Konsensus in der Erarbeitung und kontinuierlichen
Adaptation diagnostischer Kriterien im Bereich der Organtransplantation. Alle zwei Jahre finden Banff-Meetings statt. Mit
dem Ziel, die diagnostischen Kriterien in den verschiedenen Organsystemen dem jeweiligen Erkenntnisstand anzupassen, werden
neue Daten präsentiert und diskutiert. Die 10.Banff-Konferenz fand vom 9.bis 14.August 2009 in Banff, Kanada, statt. 263Pathologen,
Kliniker, Chirurgen, Immunologen, Gewebetypisierer und Wissenschaftler diskutierten verschiedene aktuelle Aspekte der Organtransplantation.
Schwerpunkte waren diagnostische Kriterien der antikörpervermittelten Abstoßungsreaktion und die Etablierung von sechs Banff
Working Groups. Diese Arbeitsgruppen organisieren multizentrische Studien zur Generierung von Daten, die eine evidenzbasiert
Behebung identifizierter Schwachpunkte in der Klassifikation ermöglichen. Auf diesen Daten basierende Änderungen der Banff-Klassifikation
müssen die Kriterien klinischer Relevanz, Reproduzierbarkeit und Praktikabilität erfüllen. Außerdem wurden bei der Konferenz
Ergebnisse aus dem Bereich der molekularen Transplantationspathologie präsentiert, die eine baldige Integration molekularer
Diagnostik in die Banff-Klassifikation erwarten lassen.

The Banff working group for allograft pathology represents the international consensus platform for generating and refining
diagnostic standards in the area of organ transplantation. Every 2 years a Banff meeting is held and participants review recent
data in the field, aiming to adjust the classification systems to current knowledge. The 10th Banff Conference on Allograft
Pathology was held in Banff, Canada from August 9 to 14, 2009. A total of 263 transplant clinicians, pathologists, surgeons,
immunologists, and researchers discussed several aspects of solid organ transplants with a special focus on antibody-mediated
graft injury. The willingness of the Banff process to adapt continuously in response to new research and improve potential
weaknesses in a data-driven, evidence-based way led to the implementation of six working groups in the following areas: isolated
v-lesion, fibrosis scoring, glomerular lesions, molecular pathology, polyomavirus nephropathy, and quality assurance. Banff
working groups will conduct multicenter trials to evaluate the clinical relevance, practical feasibility, and reproducibility
of potential changes to the Banff classification. In addition, compelling molecular research data led to the discussion of
combining histopathology and molecular parameters within the Banff working classification in the near-future.

SchlüsselwörterBanff-Klassifikation-Diagnostik-Organtransplantation-„Chronic allograft nephropathy“-Antikörpervermittelte Abstoßung
KeywordsBanff classification-Diagnosis-Organ transplant-“Chronic allograft nephropathy”-Antibody-mediated rejection

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    ABSTRACT: Staining of C4d in graft capillaries has emerged as a useful method to detect antibody-mediated rejections in situ. Demonstration of capillary C4d has provided substantial clinical results and allows several conclusions: Antidonor antibodies (preformed or produced de novo) activate complement directly in the graft. Capillary C4d is present in about 30% of biopsies with acute and chronic rejections and separates rejections with a humoral component from 'pure' cell-mediated rejections. Recognition of humoral alloreactivity is important, since effective treatment is now available. Since capillary C4d can appear and disappear at any time post transplantation, every transplant biopsy should be tested. Capillary C4d is now incorporated in the 'Banff classification'. The incidence of C4d-positive cases will probably decline because of the 'routine' application of potent immunosuppressants, including mycophenolate mofetil, that can inhibit antibody production. Presensitization, however, will remain a potential threat to allografts.
    American Journal of Transplantation 07/2003; 3(6):646-52. DOI:10.1034/j.1600-6143.2003.00171.x · 5.68 Impact Factor
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    ABSTRACT: Antibody-mediated rejection (AbAR) is increasingly recognized in the renal allograft population, and successful therapeutic regimens have been developed to prevent and treat AbAR, enabling excellent outcomes even in patients highly sensitized to the donor prior to transplant. It has become critical to develop standardized criteria for the pathological diagnosis of AbAR. This article presents international consensus criteria for and classification of AbAR developed based on discussions held at the Sixth Banff Conference on Allograft Pathology in 2001. This classification represents a working formulation, to be revisited as additional data accumulate in this important area of renal transplantation.
    American Journal of Transplantation 07/2003; 3(6):708-14. DOI:10.1034/j.1600-6143.2003.00072.x · 5.68 Impact Factor
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    ABSTRACT: In renal transplantation, clinical decisions are based primarily on the Banff classification of biopsies. However, the incorporation of 'minor or nonspecific' cellular infiltrates into the Banff classification and their interpretation is uncertain. We analyzed 833 protocol and 306 indicated biopsies to test whether such infiltrates are harmless or whether they have a bearing on outcomes. We characterized morphology, localization and cellular composition of infiltrates, and correlated these findings to the Banff classification and allograft outcome. We found that protocol biopsies had the same prevalence of infiltrates as indication biopsies (87% vs. 87%). Diffuse cortical infiltrates, the hallmark of cellular rejection were more common in indication biopsies and related to tubulitis and a rise in serum creatinine. However, in biopsies with cellular rejection according to Banff criteria, we observed an increase in all infiltrate types (specific and nonspecific) and all cell types (T cells, B cells, histiocytes). The only predictor of allograft function outcome was persistent inflammation in sequential biopsies, irrespective of type, localization and composition of the cellular infiltrates. As detected by sequential biopsies, persistence of any inflammation including those infiltrates currently not considered by the Banff classification should be regarded as a morphological correlate of ongoing allograft damage.
    American Journal of Transplantation 03/2007; 7(2):356-65. DOI:10.1111/j.1600-6143.2006.01635.x · 5.68 Impact Factor
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