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

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.
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It has continued to evolve through
meetings every two years and has
become the worldwide standard for
interpretation of transplant biopsies.
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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
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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
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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
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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
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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
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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
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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
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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!
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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!
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Future Banff Meetings:
 2005 - Edmonton, Alberta, Canada
 2007 - Edinburgh, Scotland
 2009 - Banff, Alberta, Canada
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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
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