Banff 2022 Kidney Commentary: Reflections and Future Directions

医学 肾病科 肾移植 移植 供体特异性抗体 肾脏疾病 病理 内科学 重症监护医学
作者
Marion Rabant,Benjamin Adam,Olivier Aubert,Georg A. Böhmig,Marian Clahsen Van-Groningen,Lynn D. Cornell,Aiko P. J. de Vries,Edmund Huang,Nicolas Kozakowski,Agnieszka Perkowska‐Ptasińska,Leonardo V. Riella,Ivy A. Rosales,Carrie Schinstock,Naomi Simmonds,Olivier Thaunat,Michelle Willicombe
出处
期刊:Transplantation [Ovid Technologies (Wolters Kluwer)]
被引量:2
标识
DOI:10.1097/tp.0000000000005112
摘要

In September 2022, in Banff, Alberta, Canada, the XVIth Banff meeting, corresponding to the 30th anniversary of the Banff classification, was held, leading to 2 recent publications. Discussions at the Banff meeting focused on proposing improvements to the Banff process as a whole. In line with this, a unique opportunity was offered to a selected group of 16 representatives from the pathology and transplant nephrology community, experts in the field of kidney transplantation, to review these 2 Banff manuscripts. The aim was to provide an insightful commentary, to gauge any prospective influence the proposed changes may have, and to identify any potential areas for future enhancement within the Banff classification. The group expressed its satisfaction with the incorporation of 2 new entities, namely “microvascular inflammation/injury donor-specific antibodies–negative and C4d negative” and “probable antibody-mediated rejection,” into category 2. These changes expand the classification, facilitating the capture of more biopsies and providing an opportunity to explore the clinical implications of these lesions further. However, we found that the Banff classification remains complex, potentially hindering its widespread utilization, even if a degree of complexity may be unavoidable given the intricate pathophysiology of kidney allograft pathology. Addressing the histomorphologic diagnosis of chronic active T cell–mediated rejection (CA TCMR), potentially reconsidering a diagnostic-agnostic approach, as for category 2, to inflammation in interstitial fibrosis and tubular atrophy and chronic active T cell–mediated rejection was also an important objective. Furthermore, we felt a need for more evidence before molecular diagnostics could be routinely integrated and emphasized the need for clinical and histologic context determination and the substantiation of its clinical impact through rigorous clinical trials. Finally, our discussions stressed the ongoing necessity for multidisciplinary decision-making regarding patient care.
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