Reproducibility of the Banff classification in subclinical kidney transplant rejection

Authors

  • Francisco Veríssimo Veronese,

    1.  Renal Division, Hospital de Clínicas de Porto Alegre and Post-Graduation Nephrology Program, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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  • Roberto Ceratti Manfro,

    1.  Renal Division, Hospital de Clínicas de Porto Alegre and Post-Graduation Nephrology Program, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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  • Fernando Roberto Roman,

    1.  Renal Division, Hospital de Clínicas de Porto Alegre and Post-Graduation Nephrology Program, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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  • Maria Isabel Edelweiss,

    1.  Pathology Division, Hospital de Clínicas de Porto Alegre and Post-Graduation Nephrology Program, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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  • David N Rush,

    1.  Internal Medicine Department, University of Manitoba, Winnipeg, Canada
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  • Sylvia Dancea,

    1.  Pathology Department, University of Manitoba, Winnipeg, Canada
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  • Julio Goldberg,

    1.  Transplant Division, Instituto de Nefrologia, Buenos Aires, Argentina
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  • Luiz Felipe Gonçalves

    1.  Renal Division, Hospital de Clínicas de Porto Alegre and Post-Graduation Nephrology Program, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Francisco V. Veronese, MD, Renal Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, ZIP 90035-003, Porto Alegre, RS, Brazil.
Tel.: 55.51.21018295; fax: 55.51.21012181;
e-mail: fveronese@hcpa.ufrgs.br

Abstract

Abstract:  The Banff classification for kidney allograft pathology has proved to be reproducible, but its inter and intraobserver agreement can vary substantially among centres. The aim of this study was to evaluate Banff reproducibility of surveillance renal allograft biopsies among renal pathologists from different transplant centres. This study included 32 renal transplant patients with stable graft function. Biopsies were performed 2 and 12 months post-transplant. Histology was interpreted according to the Banff schema by three renal pathologists, and inter and intraobserver agreement were measured. The best reproducibility was obtained for the presence or absence of acute rejection (AR), with kappa values ranging from moderate (κ = 0.47; p = 0.006) to good (κ = 0.72; p = 0.0001). However, the agreement for ‘suspicious for AR’ category was poor between all observers. For scoring and grading interstitial inflammation and intimal arteritis the agreement were poor and moderate, respectively. Reproducibility for the presence or absence of chronic allograft nephropathy (CAN) was heterogeneous, ranging from poor (κ = 0.13; p = NS) to moderate (κ = 0.56; p = 0.007). Scoring chronic changes such as fibrous intimal thickening gave a reasonable interobserver agreement. Intraobserver reproducibility was good for presence or absence of AR, but was poor for the diagnosis of CAN. In conclusion, histologic analysis of stable renal allografts based on Banff criteria showed a good agreement for the diagnosis of AR and a reasonable kappa for CAN, but reproducibility for scoring and grading showed a substantial interobserver variation.

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