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Banff Schema for Grading Pancreas Allograft Rejection: Working Proposal by a Multi-Disciplinary International Consensus Panel

  1. C. B. Drachenberg1,*,
  2. J. Odorico2,
  3. A.J. Demetris3,
  4. L. Arend4,
  5. I. M. Bajema5,
  6. J. A. Bruijn5,
  7. D. Cantarovich6,
  8. H. P. Cathro7,
  9. J. Chapman8,
  10. K. Dimosthenous9,
  11. B. Fyfe-Kirschner10,
  12. L. Gaber11,
  13. O. Gaber12,
  14. J. Goldberg13,
  15. E. Honsová14,
  16. S. S. Iskandar15,
  17. D. K. Klassen16,
  18. B. Nankivell8,
  19. J. C. Papadimitriou1,
  20. L. C. Racusen17,
  21. P. Randhawa3,
  22. F. P. Reinholt18,
  23. K. Renaudin19,
  24. P. P. Revelo20,
  25. P. Ruiz21,
  26. J. R. Torrealba22,
  27. E. Vazquez-Martul23,
  28. L. Voska14,
  29. R. Stratta24,
  30. S. T. Bartlett25,
  31. D. E. R. Sutherland26

Article first published online: 29 APR 2008

DOI: 10.1111/j.1600-6143.2008.02212.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 8, Issue 6, pages 1237–1249, June 2008

Additional Information

How to Cite

Drachenberg, C. B., Odorico, J., Demetris, A., Arend, L., Bajema, I. M., Bruijn, J. A., Cantarovich, D., Cathro, H. P., Chapman, J., Dimosthenous, K., Fyfe-Kirschner, B., Gaber, L., Gaber, O., Goldberg, J., Honsová, E., Iskandar, S. S., Klassen, D. K., Nankivell, B., Papadimitriou, J. C., Racusen, L. C., Randhawa, P., Reinholt, F. P., Renaudin, K., Revelo, P. P., Ruiz, P., Torrealba, J. R., Vazquez-Martul, E., Voska, L., Stratta, R., Bartlett, S. T. and Sutherland, D. E. R. (2008), Banff Schema for Grading Pancreas Allograft Rejection: Working Proposal by a Multi-Disciplinary International Consensus Panel. American Journal of Transplantation, 8: 1237–1249. doi: 10.1111/j.1600-6143.2008.02212.x

Author Information

  1. 1

    Department of Pathology, University of Maryland School of Medicine, Baltimore, MD

  2. 2

    Department of Surgery, University of Wisconsin-Madison, Madison, WI

  3. 3

    Division of Transplantation Pathology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA

  4. 4

    Department of Pathology and Laboratory Medicine, University of Cincinnati Medical Center, Cincinnati, OH

  5. 5

    Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands

  6. 6

    Department of Nephrology, CHU – Hôtel Dieu, Nantes, France

  7. 7

    Department of Pathology, University of Virginia, Charlottesville, VA

  8. 8

    Department of Renal Medicine, University of Sydney, Westmead Hospital, Sydney, Australia

  9. 9

    Department of Pathology, Evangelismos Hospital, Athens, Greece

  10. 10

    Department of Pathology, Robert Wood Johnson University, New Brunswick, NJ

  11. 11

    Department of Pathology, University of Tennessee Health Science Center, Memphis, TN

  12. 12

    Department of Surgery, The Methodist Hospital, Houston TX

  13. 13

    Instituto de Nefrologia, Buenos Aires, Argentina

  14. 14

    Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

  15. 15

    Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC

  16. 16

    Department of Medicine, University of Maryland School of Medicine, Baltimore, MD

  17. 17

    Department of Pathology, John Hopkins University, Baltimore, MD

  18. 18

    Institute of Pathology, University of Oslo and Division of Pathology, Rikshospitalet University Hospital, Oslo, Norway

  19. 19

    Anatomie et Cytologie Pathologiques CHU – Hôtel Dieu, Nantes, France

  20. 20

    Department of Pathology and Laboratory Medicine, University of Utah, Salt Lake City, UT

  21. 21

    Departments of Pathology and Surgery, University of Miami, Miami, FL

  22. 22

    Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI

  23. 23

    Departmento de Patologia, CHU Canalejo, A Coruňa, Spain

  24. 24

    Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC

  25. 25

    Department of Surgery, University of Maryland School of Medicine, Baltimore, MD

  26. 26

    Department of Surgery, Division of Transplantation and Diabetes Institute for Immunology and Transplantation, University of Minnesota, Minneapolis, MN

* * Corresponding author: Cinthia B. Drachenberg, cdrac001@umaryland.edu

Publication History

  1. Issue published online: 30 MAY 2008
  2. Article first published online: 29 APR 2008
  3. Received 4 December 2007, revised 23 January 2007 and accepted for publication 8 February 2008

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Keywords:

  • Acute allograft rejection;
  • acute cellular rejection;
  • allograft arteriopathy;
  • allograft function;
  • allograft loss;
  • allograft monitoring;
  • anti-HLA antibodies;
  • antibody-mediated rejection;
  • Banff schema;
  • biopsy specimen;
  • pancreas;
  • pancreas allograft;
  • pancreas and kidney;
  • pancreatic islets;
  • pathology

This document proposes a working schema for histological diagnosis and grading of cell mediated and humoral allograft rejection in the pancreas, including stages of chronic rejection/graft sclerosis, criteria for needle core biopsy adequacy and guidelines for pathology reporting.

Accurate diagnosis and grading of rejection and other pathological processes are of paramount importance to guide therapeutic interventions in patients with pancreas allograft dysfunction. A multi-disciplinary panel of pathologists, surgeons and nephrologists was convened for the purpose of developing a consensus document delineating the histopathological features for diagnosis and grading of rejection in pancreas transplant biopsies. Based on the available published data and the collective experience, criteria for the diagnosis of acute cell-mediated allograft rejection (ACMR) were established. Three severity grades (I/mild, II/moderate and III/severe) were defined based on lesions known to be more or less responsive to treatment and associated with better- or worse-graft outcomes, respectively. The features of chronic rejection/graft sclerosis were reassessed, and three histological stages were established. Tentative criteria for the diagnosis of antibody-mediated rejection were also characterized, in anticipation of future studies that ought to provide more information on this process. Criteria for needle core biopsy adequacy and guidelines for pathology reporting were also defined.

The availability of a simple, reproducible, clinically relevant and internationally accepted schema for grading rejection should improve the level of diagnostic accuracy and facilitate communication between all parties involved in the care of pancreas transplant recipients.

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