The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell- and antibody-mediated rejection

Alexandre Loupy, Mark Haas, Candice Roufosse, Maarten Naesens, Benjamin Adam, Marjan Afrouzian, Enver Akalin, Nada Alachkar, Serena Bagnasco, Jan U Becker, Lynn D Cornell, Marian C Clahsen-van Groningen, Anthony J Demetris, Duska Dragun, Jean-Paul Duong van Huyen, Alton B Farris, Agnes B Fogo, Ian W Gibson, Denis Glotz, Juliette Gueguen, Zeljko Kikic, Nicolas Kozakowski, Edward Kraus, Carmen Lefaucheur, Helen Liapis, Roslyn B Mannon, Robert A Montgomery, Brian J Nankivell, Volker Nickeleit, Peter Nickerson, Marion Rabant, Lorraine Racusen, Parmjeet Randhawa, Blaise Robin, Ivy A Rosales, Ruth Sapir-Pichhadze, Carrie A Schinstock, Daniel Seron, Harsharan K Singh, Rex N Smith, Mark D Stegall, Adriana Zeevi, Kim Solez, Robert B Colvin, Michael Mengel, Alexandre Loupy, Mark Haas, Candice Roufosse, Maarten Naesens, Benjamin Adam, Marjan Afrouzian, Enver Akalin, Nada Alachkar, Serena Bagnasco, Jan U Becker, Lynn D Cornell, Marian C Clahsen-van Groningen, Anthony J Demetris, Duska Dragun, Jean-Paul Duong van Huyen, Alton B Farris, Agnes B Fogo, Ian W Gibson, Denis Glotz, Juliette Gueguen, Zeljko Kikic, Nicolas Kozakowski, Edward Kraus, Carmen Lefaucheur, Helen Liapis, Roslyn B Mannon, Robert A Montgomery, Brian J Nankivell, Volker Nickeleit, Peter Nickerson, Marion Rabant, Lorraine Racusen, Parmjeet Randhawa, Blaise Robin, Ivy A Rosales, Ruth Sapir-Pichhadze, Carrie A Schinstock, Daniel Seron, Harsharan K Singh, Rex N Smith, Mark D Stegall, Adriana Zeevi, Kim Solez, Robert B Colvin, Michael Mengel

Abstract

The XV. Banff conference for allograft pathology was held in conjunction with the annual meeting of the American Society for Histocompatibility and Immunogenetics in Pittsburgh, PA (USA) and focused on refining recent updates to the classification, advances from the Banff working groups, and standardization of molecular diagnostics. This report on kidney transplant pathology details clarifications and refinements to the criteria for chronic active (CA) T cell-mediated rejection (TCMR), borderline, and antibody-mediated rejection (ABMR). The main focus of kidney sessions was on how to address biopsies meeting criteria for CA TCMR plus borderline or acute TCMR. Recent studies on the clinical impact of borderline infiltrates were also presented to clarify whether the threshold for interstitial inflammation in diagnosis of borderline should be i0 or i1. Sessions on ABMR focused on biopsies showing microvascular inflammation in the absence of C4d staining or detectable donor-specific antibodies; the potential value of molecular diagnostics in such cases and recommendations for use of the latter in the setting of solid organ transplantation are presented in the accompanying meeting report. Finally, several speakers discussed the capabilities of artificial intelligence and the potential for use of machine learning algorithms in diagnosis and personalized therapeutics in solid organ transplantation.

Keywords: classification systems: Banff classification; clinical decision-making; clinical research/practice; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; molecular biology: mRNA/mRNA expression; pathology/histopathology; rejection; translational research/science.

Conflict of interest statement

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Michael Mengel received honoraria from Novartis, CSL Behring, and Vitaeris. Mark Haas received consulting fees from Shire ViroPharma, AstraZeneca, Novartis, and CareDx, and honoraria from CareDx. Denis Glotz received honoraria from Sanofi and CSL Behring and consulting fees from BMS and Atara. Roslyn Mannon has received grant funding from CSL Behring, CareDX, Vitaeris, Astellas, and Transplant Genomics, and honoraria from Hansa, Novartis, CSL Behring, and Vitaeris. Robert Colvin is a consultant for Shire ViroPharma, CSL Behring, Alexion, and eGenesis. AJ Demetris is consultant for Novartis and TransMedics, Robert Montgomery received honoraria, consulting fees, or travel expenses from Alexion, Hansa Medical, CSL Behring, Sanofi, Novartis, Viela Bio, Vitaeris Bio, Terasaki Foundation, and Shire/Takeda.

© 2020 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1
Figure 1
Responses to TTS survey regarding the management of chronic active (CA) TCMR: of the 128 respondents to this survey, 47 (37%) were from Europe, 26 (20%) from Asia, 23 (18%) from the United States and Canada, 18 (14%) from Latin America, 9 (7%) from the Middle East and Africa, and 5 (4%) from Australia and New Zealand. Sixty‐five percent of centers performed 200. At all but 12% of centers, biopsies were read by a renal or transplant pathologist

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