The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials
Author(s)
Type
Journal Article
Abstract
The kidney sessions of the 2017 Banff Conference focused on 2 areas: clinical implications of inflammation in areas of interstitial fibrosis and tubular atrophy (i‐IFTA) and its relationship to T cell–mediated rejection (TCMR), and the continued evolution of molecular diagnostics, particularly in the diagnosis of antibody‐mediated rejection (ABMR). In confirmation of previous studies, it was independently demonstrated by 2 groups that i‐IFTA is associated with reduced graft survival. Furthermore, these groups presented that i‐IFTA, particularly when involving >25% of sclerotic cortex in association with tubulitis, is often a sequela of acute TCMR in association with underimmunosuppression. The classification was thus revised to include moderate i‐IFTA plus moderate or severe tubulitis as diagnostic of chronic active TCMR. Other studies demonstrated that certain molecular classifiers improve diagnosis of ABMR beyond what is possible with histology, C4d, and detection of donor‐specific antibodies (DSAs) and that both C4d and validated molecular assays can serve as potential alternatives and/or complements to DSAs in the diagnosis of ABMR. The Banff ABMR criteria are thus updated to include these alternatives. Finally, the present report paves the way for the Banff scheme to be part of an integrative approach for defining surrogate endpoints in next‐generation clinical trials.
Date Issued
2018-02-01
Online Publication Date
2018-02-01
2018-06-08T14:57:16Z
Date Acceptance
2017-12-07
ISSN
1600-6135
Publisher
WILEY
Start Page
293
End Page
307
Journal / Book Title
AMERICAN JOURNAL OF TRANSPLANTATION
Volume
18
Issue
2
Copyright Statement
© 2017 The Authors. American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Source Database
web-of-science
Sponsor
Roche Organ Transplant Research Foundation
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000423666200005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
n/a
RDA28
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
Transplantation
classification systems: Banff classification
kidney transplantation/nephrology
molecular biology
pathology/histopathology
rejection
translational research/science
DONOR-SPECIFIC ANTIBODIES
ACUTE HUMORAL REJECTION
RENAL-ALLOGRAFTS
TRANSPLANT RECIPIENTS
MOLECULAR ASSESSMENT
BIOPSIES
C4D
IMMUNOSUPPRESSION
CLASSIFICATION
INFLAMMATION
11 Medical And Health Sciences
Publication Status
Published
Date Publish Online
2018-01-21