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The Banff Cl assification: 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. The Banff Schema was first developed by a

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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.

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.

It has continued to evolve through

meetings every two years and has

become the worldwide standard for

interpretation of transplant biopsies.

banff classification milestones
Banff Classification: Milestones
  • 1991 First Conference
  • 1993 First Kidney International publication
  • 1995 Integration with CADI - identical scoring
  • 1997 Integration with CCTT classification
  • 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies, microwave.
  • 2001 Classification of antibody-mediated rejection
    • Regulatory agencies participating
quantitative criteria for arteriolar hyaline thickening
Quantitative Criteria for Arteriolar Hyaline Thickening

0 = No PAS-positive hyaline thickening

1 = Mild-to-moderate PAS-positive hyaline thickening in at least one arteriole

2 = Moderate-to-severe PAS-positive hyaline thickening in more than one arteriole

3 = Severe PAS-positive hyaline thickening in many arterioles

changes not considered to be due to rejection
Changes not considered to be due to rejection
  • Post-transplant lymphoproliferative disorder
  • Non-specific changes
      • focal interstitial inflammation without tubulitis: Nodular infiltrates, perivascular infiltrates
      • vascular changes: endothelial reactive changes, vacuolization, venulitis.
  • Acute Tubular Injury
  • Acute Interstitial Nephritis
  • Cyclosporine-associated changes, acute or chronic
  • Subcapsular Injury
  • Pre-transplant Acute Endothelial Injury
  • Papillary Necrosis
  • De novo Glomerulonephritis
  • Recurrent Disease
  • Pre-existing Disease
  • Other-viral infection (CMV), obstruction and reflux
specimen adequacy banff 97 minimum sampling
Specimen Adequacy – (Banff ’97) Minimum Sampling
  • Unsatisfactory – No glomeruli or arteries
  • Marginal – 7 glomeruli with an artery
  • Adequate – 10 or more glomeruli with at least two arteries
  • Minimum Sampling: 7 slides – 3 H&E, 3 PAS or silver stains, and 1 trichrome
standardization of tx biopsy interpretation banff classification
Standardization of tx biopsy interpretation. Banff Classification
  • Classification begun at 1991
    • Banff meeting has become the worldwide standard
    • Consensus process has now extended to all solid organs
    • Meetings continue every two years. Next meeting in Edmonton in summer of 2005
  • Future meetings planned every two years through 2009
  • Standardization principles now being extended from biopsy reporting to tissue typing, imaging, all the other elements in transplant care
standardization of tx biopsy interpretation banff classification13
Standardization of tx biopsy interpretation. Banff Classification
  • Lesion quantitation
  • Reproducibility and clinical validation studies
  • Involvement of pathologists, clinicians, surgeons, scientists, registries, and regulatory agencies in consensus generation
  • Meetings have large amount of unstructured time for deliberation and consensus generation
  • Most content online at: http://cnserver0.nkf.med.ualberta.ca/Banff
  • Linked from http://www.cybernephrology.org
agreed upon clinical practice guidelines that need buy in generally
Agreed upon clinical practice guidelines that need buy-in generally
  • Implantation biopsies
  • Rapid paraffin (microwave) processing for rapid reading rather than frozen sections
  • Routine (“protocol”) biopsies
  • H&E, PAS (+/o silver), and trichrome or Sirius red stains
perioperative implantation biopsy
Perioperative (implantation) Biopsy
  • Core vs wedge
  • Adequacy of sample
  • Preimplantation vs. postimplantation
  • Consensus:
    • Perioperative biopsy (? core, ? wedge) is sufficiently safe to be recommended for any reasonable defined objective

STANDARD OF CARE!

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

STANDARD OF SCIENCE!

future banff meetings
Future Banff Meetings:
  • 2005 - Edmonton, Alberta, Canada
  • 2007 - Edinburgh, Scotland
  • 2009 - Banff, Alberta, Canada
close
Close
  • Banff ’97 Classification is the new universal classification of kidney transplant pathology
  • 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
Subscribe to free Nephrol Email group:Become part of the ongoing discussions

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