Mubarak M, Raza A, Rashid R, Shakeel S. Evolution of human kidney allograft pathology diagnostics through 30 years of the Banff classification process. World J Transplant 2023; 13(5): 221-238 [PMID: 37746037 DOI: 10.5500/wjt.v13.i5.221]
Corresponding Author of This Article
Muhammed Mubarak, MD, Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation, Dewan Farooque Medical Complex, Karachi 74200, Sindh, Pakistan. drmubaraksiut@yahoo.com
Research Domain of This Article
Pathology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2023; 13(5): 221-238 Published online Sep 18, 2023. doi: 10.5500/wjt.v13.i5.221
Table 1 Adequacy criteria of renal allograft biopsies for an accurate pathologic diagnosis
Parameters/investigations
Requirements
Number of cores
Two (these should be divided to procure tissue for IF and EM studies, if necessary)
Components of graft parenchyma
Both cortex and medulla
For the light microscopic study
A significant amount of cortex containing up to: (1) 10 glomeruli; and (2) 2 arteries
For the immunofluorescence study
Cortex with up to 3 glomeruli
For the electron microscopic study
Cortex with 1 glomerulus
Table 2 Banff reporting standardization template according to the Banff 2019 meeting
Components of the allograft
Acute lesions
Scoring as 0, 1, 2, 3
Chronic lesions
Scoring as 0, 1, 2, 3
Acute & chronic lesions
Scoring as 0, 1, 2, 3
Glomeruli
g
-
cg
-
Interstitium
i
-
ci
-
ti, i-IFTA
-
Tubules
t
-
ct
-
t-IFTA
-
Vessels
v
-
cv
-
Peritubular capillaries
ptc
-
ptcml
-
C4d
C4d
-
Table 3 Main changes in the nomenclature and classification of antibody-mediated rejection in the Banff classification over three decades of evolution (1991 to 2019)
Diagnostic criteria for acute antibody-mediated rejection were developed. Three types were described as: (1) Types I: ATN-like3; (2) Types II: Capillary3; and (3) Type III: Arterial3
Banff, 2005
Diagnostic criteria for chronic antibody-mediated rejection were developed
Table 4 Main changes in the nomenclature and classification of T cell-mediated rejection in the Banff classification over three decades of evolution (1991 to 2019)
Chronic active2 (includes only transplant arteriopathy)
Banff, 2007
TCMR
Acute
Chronic active (includes only transplant arteriopathy)
Banff, 2013
TCMR
Acute
Chronic active (includes only transplant arteriopathy)
Banff, 2015
TCMR
Acute
Chronic active TCMR may have tubulointerstitial changes2
Banff, 2017
TCMR
Acute
Chronic active TCMR grades I A/B and II defined
Banff, 2019
i-IF/TA and t-IF/TA included in criteria2 (inflammation and tubulitis in areas of scarring)
In chronic active TCMR with i >1, diagnosis to be combined chronic active and acute TCMR2
Table 5 Main changes in the nomenclature and classification of chronic changes of the allograft in the Banff classification over three decades of evolution (1991 to 2019)
Meeting reports, year
Category 5: Chronic allograft nephropathy
Banff, 1993
CAN, grades, I, II, III
Banff, 1997
CAN, grades, I, II, III, each divided into a and b subcategories1
Grading of polyoma viral nephropathy into classes 1, 2 and 3 (adequate sampling for scoring should include 2 cores with medulla)1
Citation: Mubarak M, Raza A, Rashid R, Shakeel S. Evolution of human kidney allograft pathology diagnostics through 30 years of the Banff classification process. World J Transplant 2023; 13(5): 221-238