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Slide 1
PUBLICATIONS
 Racusen/Solez meeting report for AJT.
 Manuscript on antibody-mediated rejection.
 Manuscript on recurrent autoimmune hepatitis.
 The editor of the Journal of Heart and Lung
Transplantation (Dr. James Kirklin) requested a written
set of suggestions from the Banff working group to be
forwarded to the council of the International Society of
Heart and Lung Transplantation
Slide 2
Criteria for Acute Antibody Mediated
Rejection (Provisional - Need 1, 2, and 3)
 1. Morphologic evidence of acute tissue injury,
such as: a. acute tubular injury b. neutrophils
and/or monos in PTC and/or glomeruli, or c.
fibrinoid necrosis and transmural inflammation in
arteries
 2. Immunopathologic evidence for antibody
action, such as : a. C4d in PTC or b.
Immunoglobulin and complement in fibrinoid
necrosis
 3. Serologic evidence of anti-HLA or other antidonor antibodies .
Slide 3
Criteria for Acute Antibody Mediated
Rejection
 Samples that meet the criteria for acute cellular
rejection (Banff I and II) and have the criterion 2
and 3 above are classified as combined cellular
and humoral rejection.
Slide 4
Chronic Rejection Classification Current Banff ‘97
 Chronic/Scleros. Allograft Nephropathy¤
 Grade I (mild) Mild interstitial fibrosis and
tubular atrophy without (a) or with (b) specific
changes suggesting chronic rejection
 Grade II Moderate interstitial fibrosis and
tubular atrophy (moderate) (a) or (b)
 Grade III Severe interstitial fibrosis and tubular
atrophy and tubular loss(severe) (a) or (b)
Slide 5
Chronic Rejection Classification Current Banff ‘97 cont.
 ¤ Glomerular and vascular lesions help define
type of chronic nephropathy; chronic/recurrent
rejection can be diagnosed if typical vascular
lesions are seen.
 (Activity. - Immunologic and fibrotic activity
indicators - C4D staining, and presence of
mononuclear inflammatory cells in the fibrous
arterial intima. PTC splitting and lamination have
a significance similar to chronic transplant
glomerulopathy. ? Role of collagen subtypes,
smooth muscle cell actin,elastic tissue stains,
molecular markers. Dan paragraph to come.)
Slide 6
Chronic Rejection Classification Current Banff ‘97 cont.
 For studies at least two biopsies, more
quantitation
Slide 7
Chronic Rejection Classification - Hope
for the Future after Studies Completed
 Chronic Allograft Dysfunction Classification
1. No biopsy. Otherwise unexplained chronic
progressive dysfunction.
2. Biopsy. Uninstructive/Instructive specific Acute rejection, recurrent disease,
cyclosporine or FK toxicity, hypertensive
vasc. disease or: CAN (IF TA, FIT)(1-3)
Nonimmunologic.
Immunologic Changes - C4d, PTC splitting,
Mihatsch light microscopic criteria