The Banff Classification: Slide Seminar

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The Banff Classification Slide Seminar

• Kim Solez, M.D.

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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.
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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
  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

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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
• Other-viral infection (CMV), obstruction and
  reflux

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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 HE, 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.u
  alberta.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
• HE, 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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