The Banff Classification Slide Seminar Kim Solez M

The Banff Classification: Slide Seminar Kim Solez, M. D.

The Banff Schema was first developed by a group of pathologists, nephrologists, and transplant surgeons at a meeting in Banff Canada August 2 -4, 1991. 2 It has continued to evolve through meetings every two years and has become the worldwide standard for interpretation of transplant biopsies.

3 Banff Classification: Milestones n 1991 First Conference n 1993 First Kidney International publication n 1995 Integration with CADI - identical scoring n 1997 Integration with CCTT classification n 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies, microwave. n 2001 Classification of antibody-mediated rejection n Regulatory agencies participating

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8 Quantitative Criteria for Arteriolar Hyaline Thickening 0 = No PAS-positive hyaline thickening 1 = Mild-to-moderate PAS-positive hyaline in at least one arteriole thickening 2 = Moderate-to-severe PAS-positive hyaline thickening in more than one arteriole 3 = Severe PAS-positive hyaline thickening in many arterioles

9 Changes not considered to be due to rejection n Post-transplant lymphoproliferative disorder n Non-specific changes n focal interstitial inflammation without tubulitis: Nodular infiltrates, perivascular infiltrates n vascular changes: endothelial reactive changes, vacuolization, venulitis. n Acute Tubular Injury n Acute Interstitial Nephritis n Cyclosporine-associated changes, acute or chronic n Subcapsular Injury n Pre-transplant Acute Endothelial Injury n Papillary Necrosis n De novo Glomerulonephritis n Recurrent Disease n Pre-existing Disease

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11 Specimen Adequacy – (Banff ’ 97) Minimum Sampling n Unsatisfactory – No glomeruli or arteries n Marginal – 7 glomeruli with an artery n Adequate – 10 or more glomeruli with at least two arteries n Minimum Sampling: 7 slides – 3 H&E, 3 PAS or silver stains, and 1 trichrome

12 Standardization of tx biopsy interpretation. Banff Classification n Classification begun at 1991 n Banff meeting has become the worldwide standard n Consensus process has now extended to all solid organs n Meetings continue every two years. Next meeting in Edmonton in summer of 2005 n Future meetings planned every two years through 2009 n Standardization principles now being extended from biopsy reporting to tissue typing, imaging, all the other elements in transplant care

13 Standardization of tx biopsy interpretation. Banff Classification n Lesion quantitation n Reproducibility and clinical validation studies n Involvement of pathologists, clinicians, surgeons, scientists, registries, and regulatory agencies in consensus generation n Meetings have large amount of unstructured time for deliberation and consensus generation n Most content online at: http: //cnserver 0. nkf. med. ualberta. ca/Banff n Linked from http: //www. cybernephrology. org

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17 Agreed upon clinical practice guidelines that need buy-in generally n Implantation biopsies n Rapid paraffin (microwave) processing for rapid reading rather than frozen sections n Routine (“protocol”) biopsies n H&E, PAS (+/o silver), and trichrome or Sirius red stains

18 Perioperative (implantation) Biopsy n Core vs wedge n Adequacy of sample n Preimplantation vs. postimplantation n Consensus: n Perioperative biopsy (? core, ? wedge) is sufficiently safe to be recommended for any reasonable defined objective STANDARD OF CARE!

19 Protocol (routine) biopsies n Early and intermediate post-transplant protocol biopsies n Consensus: n Generally done under ultrasound guidance n Have very low morbidity n Safe enough to be requested of consenting patients for research purposes when the objectives are clearly formulated and stated STANDARD OF SCIENCE!

20 Future Banff Meetings: n 2005 - Edmonton, Alberta, Canada n 2007 - Edinburgh, Scotland n 2009 - Banff, Alberta, Canada

21 Close n Banff ’ 97 Classification is the new universal classification of kidney transplant pathology n Future improvements involve participation in Banff meetings via physical presence or contributions via Internet

Subscribe to free Nephrol Email group: Become part of the ongoing discussions 22 To subscribe: send an E-mail message to majordomo@ualberta. ca with the message “subscribe Nephrol” (or Nephrol-digest) Or contact Kim. Solez@UAlberta. ca or Michele. Hales@UAlberta. ca